Provider Demographics
NPI:1891230546
Name:SPENCER, SHEILA
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:SPENCER
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 1:16110 JAMAICA AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-6139
Mailing Address - Country:US
Mailing Address - Phone:516-476-7369
Mailing Address - Fax:718-658-4653
Practice Address - Street 1:16110 JAMAICA AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-6139
Practice Address - Country:US
Practice Address - Phone:516-476-7369
Practice Address - Fax:718-658-4653
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY376K00000X376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide