Provider Demographics
NPI:1598009532
Name:CRANDON, SHEMICA AYANNA (RN)
Entity Type:Individual
Prefix:MS
First Name:SHEMICA
Middle Name:AYANNA
Last Name:CRANDON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2153 SCHENECTADY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3713
Mailing Address - Country:US
Mailing Address - Phone:347-596-2407
Mailing Address - Fax:
Practice Address - Street 1:2153 SCHENECTADY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3713
Practice Address - Country:US
Practice Address - Phone:347-596-2407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY550528163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse