Provider Demographics
NPI:1790133965
Name:FYALL, SHAMIKA (RN)
Entity Type:Individual
Prefix:
First Name:SHAMIKA
Middle Name:
Last Name:FYALL
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 1:10200 SHORE FRONT PKWY
Mailing Address - Street 2:4P
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2787
Mailing Address - Country:US
Mailing Address - Phone:347-593-9900
Mailing Address - Fax:
Practice Address - Street 1:630 FLUSHING AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5026
Practice Address - Country:US
Practice Address - Phone:718-828-2666
Practice Address - Fax:718-782-1538
Is Sole Proprietor?:No
Enumeration Date:2016-05-29
Last Update Date:2016-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY629990163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse