Provider Demographics
NPI:1659627156
Name:PRASAD, SHOMNA D (LPN)
Entity Type:Individual
Prefix:
First Name:SHOMNA
Middle Name:D
Last Name:PRASAD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 SCHERMERHORN ST # 80
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5005
Mailing Address - Country:US
Mailing Address - Phone:718-858-7200
Mailing Address - Fax:
Practice Address - Street 1:68 SCHERMERHORN ST # 80
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5005
Practice Address - Country:US
Practice Address - Phone:718-858-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275255164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse