Provider Demographics
NPI:1871179630
Name:QUANICO, SHASMIN (RN)
Entity Type:Individual
Prefix:
First Name:SHASMIN
Middle Name:
Last Name:QUANICO
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 1:3733 28TH ST APT 18
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-2639
Mailing Address - Country:US
Mailing Address - Phone:347-216-7321
Mailing Address - Fax:
Practice Address - Street 1:3733 28TH ST APT 18
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2639
Practice Address - Country:US
Practice Address - Phone:347-216-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY804653163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse