Provider Demographics
NPI:1295187656
Name:BARRY, SHANTAYLE MONIQUE (RN)
Entity Type:Individual
Prefix:
First Name:SHANTAYLE
Middle Name:MONIQUE
Last Name:BARRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 E 52ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5903
Mailing Address - Country:US
Mailing Address - Phone:347-457-9443
Mailing Address - Fax:
Practice Address - Street 1:687 E 52ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5903
Practice Address - Country:US
Practice Address - Phone:347-457-9443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY670006-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse