Provider Demographics
NPI:1790028090
Name:STALLINGS, SHAVONN CRYSTAL (NP)
Entity Type:Individual
Prefix:
First Name:SHAVONN
Middle Name:CRYSTAL
Last Name:STALLINGS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 AMSTERDAM AVE
Mailing Address - Street 2:SCRYMSER 3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1716
Mailing Address - Country:US
Mailing Address - Phone:212-523-6500
Mailing Address - Fax:212-523-5677
Practice Address - Street 1:1000 10TH AVE STE 1A-69
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-523-6424
Practice Address - Fax:212-523-6427
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305276-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health