Provider Demographics
NPI:1275270332
Name:OKAFOR, SHANNTEL RAQUEL (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:SHANNTEL
Middle Name:RAQUEL
Last Name:OKAFOR
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MS
Other - First Name:SHANNTEL
Other - Middle Name:RAQUEL
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:2057 SEAGIRT BLVD APT 1F
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5843
Mailing Address - Country:US
Mailing Address - Phone:646-932-4437
Mailing Address - Fax:
Practice Address - Street 1:2057 SEAGIRT BLVD APT 1F
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5843
Practice Address - Country:US
Practice Address - Phone:646-932-4437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY517893163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse