Provider Demographics
NPI:1407341340
Name:BARHAM, SHAQUANA
Entity Type:Individual
Prefix:
First Name:SHAQUANA
Middle Name:
Last Name:BARHAM
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 1:5704 FARRAGUT RD APT 6E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-1255
Mailing Address - Country:US
Mailing Address - Phone:646-334-7537
Mailing Address - Fax:
Practice Address - Street 1:5704 FARRAGUT RD APT 6E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-1255
Practice Address - Country:US
Practice Address - Phone:646-334-7537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-23
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350427363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal