Provider Demographics
NPI:1417310301
Name:RIQUELME, SHAINA BRIANNE (RN)
Entity Type:Individual
Prefix:
First Name:SHAINA
Middle Name:BRIANNE
Last Name:RIQUELME
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHAINA
Other - Middle Name:BRIANNE
Other - Last Name:ST.GERMAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:24 HARDENBURGH RD
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-6009
Mailing Address - Country:US
Mailing Address - Phone:845-522-9615
Mailing Address - Fax:
Practice Address - Street 1:24 HARDENBURGH RD
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566-6009
Practice Address - Country:US
Practice Address - Phone:845-522-9615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY687367163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse