Provider Demographics
NPI:1689001984
Name:SHOOSHANI, MARIANNA
Entity Type:Individual
Prefix:
First Name:MARIANNA
Middle Name:
Last Name:SHOOSHANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3313
Mailing Address - Country:US
Mailing Address - Phone:516-223-1604
Mailing Address - Fax:516-223-3508
Practice Address - Street 1:944 MERRICK RD
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3313
Practice Address - Country:US
Practice Address - Phone:516-223-1604
Practice Address - Fax:516-223-3508
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043454183500000X
FLPS30098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist