Provider Demographics
NPI:1356847404
Name:LEVINE, SHOSHANNA EVE (IBCLC, RN)
Entity Type:Individual
Prefix:MRS
First Name:SHOSHANNA
Middle Name:EVE
Last Name:LEVINE
Suffix:
Gender:F
Credentials:IBCLC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 DEAN ST APT 204
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2181
Mailing Address - Country:US
Mailing Address - Phone:919-605-6157
Mailing Address - Fax:
Practice Address - Street 1:535 DEAN ST APT 204
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2181
Practice Address - Country:US
Practice Address - Phone:919-605-6157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-88024163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant