Provider Demographics
NPI:1346407780
Name:MARSHALL, EBONI T
Entity Type:Individual
Prefix:MS
First Name:EBONI
Middle Name:T
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WOODED WAY
Mailing Address - Street 2:
Mailing Address - City:CALVERTON
Mailing Address - State:NY
Mailing Address - Zip Code:11933
Mailing Address - Country:US
Mailing Address - Phone:631-208-0343
Mailing Address - Fax:
Practice Address - Street 1:32 WOODED WAY
Practice Address - Street 2:
Practice Address - City:CALVERTON
Practice Address - State:NY
Practice Address - Zip Code:11933
Practice Address - Country:US
Practice Address - Phone:631-208-0343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2776121164W00000X
NY641304-1163W00000X, 163WP0200X, 163WM0705X, 163WH0200X, 163WC2100X, 163WD0400X, 163WE0900X, 163WG0100X, 163WG0000X, 163WG0600X, 163WH1000X, 163WI0500X, 163WP0809X, 163WX1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care