Provider Demographics
NPI:1609393248
Name:JOHNSON, SHAUNTE (LPN)
Entity Type:Individual
Prefix:
First Name:SHAUNTE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:S JOHNSON, LPN
Mailing Address - Street 1:669 MAIN ST # 1050
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-7101
Mailing Address - Country:US
Mailing Address - Phone:347-978-4577
Mailing Address - Fax:
Practice Address - Street 1:669 MAIN ST # 1050
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-7101
Practice Address - Country:US
Practice Address - Phone:347-978-4577
Practice Address - Fax:347-449-6550
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5250969164W00000X
NY251E00000X
NY329529-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No251E00000XAgenciesHome Health