Provider Demographics
NPI:1598076127
Name:COLTER, SHAWNISA (RN)
Entity Type:Individual
Prefix:
First Name:SHAWNISA
Middle Name:
Last Name:COLTER
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 1:1302 EGGERT PL
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2308
Mailing Address - Country:US
Mailing Address - Phone:917-748-4890
Mailing Address - Fax:
Practice Address - Street 1:1302 EGGERT PL
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2308
Practice Address - Country:US
Practice Address - Phone:917-748-4890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY627403251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health