Provider Demographics
NPI:1376312207
Name:STERLING, SHANICE KADINE
Entity Type:Individual
Prefix:
First Name:SHANICE
Middle Name:KADINE
Last Name:STERLING
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 1:78A E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTN STA
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1451
Mailing Address - Country:US
Mailing Address - Phone:631-925-8514
Mailing Address - Fax:
Practice Address - Street 1:78A E 3RD ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTN STA
Practice Address - State:NY
Practice Address - Zip Code:11746-1451
Practice Address - Country:US
Practice Address - Phone:631-925-8514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL344980164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse