Provider Demographics
NPI:1336304740
Name:LEE, SHEENA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1948
Mailing Address - Country:US
Mailing Address - Phone:201-904-2090
Mailing Address - Fax:201-904-2093
Practice Address - Street 1:245 MADISON AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1948
Practice Address - Country:US
Practice Address - Phone:201-904-2090
Practice Address - Fax:201-904-2093
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00202500363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical