Provider Demographics
NPI:1740958974
Name:PYSADEE, SHANEE (RN)
Entity type:Individual
Prefix:
First Name:SHANEE
Middle Name:
Last Name:PYSADEE
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 1:667 E 77TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3315
Mailing Address - Country:US
Mailing Address - Phone:347-863-1234
Mailing Address - Fax:
Practice Address - Street 1:330 W 38TH ST RM 807
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-8461
Practice Address - Country:US
Practice Address - Phone:347-863-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35936363LF0000X
NY694192163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse