Provider Demographics
NPI:1346982378
Name:MACUFF, SHANEEZA DEEN (LPN)
Entity Type:Individual
Prefix:
First Name:SHANEEZA
Middle Name:DEEN
Last Name:MACUFF
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9121 218TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1258
Mailing Address - Country:US
Mailing Address - Phone:347-251-3962
Mailing Address - Fax:
Practice Address - Street 1:9121 218TH ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1258
Practice Address - Country:US
Practice Address - Phone:347-251-3962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342949164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse