Provider Demographics
NPI:1760102651
Name:TOUSSAINT, SHAVONNIE
Entity Type:Individual
Prefix:
First Name:SHAVONNIE
Middle Name:
Last Name:TOUSSAINT
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 1:151 RICHARD CT
Mailing Address - Street 2:POMONA
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970
Mailing Address - Country:US
Mailing Address - Phone:347-385-5625
Mailing Address - Fax:
Practice Address - Street 1:151 RICHARD CT
Practice Address - Street 2:POMONA
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970
Practice Address - Country:US
Practice Address - Phone:347-385-5625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker