Provider Demographics
NPI:1922872969
Name:KUSHNER, SHAYNA R
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:R
Last Name:KUSHNER
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:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-0304
Mailing Address - Country:US
Mailing Address - Phone:845-558-5937
Mailing Address - Fax:
Practice Address - Street 1:15 BREVOORT DR APT 1B
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3077
Practice Address - Country:US
Practice Address - Phone:845-558-5937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi