Provider Demographics
NPI:1942841200
Name:RANGER- HUTCHINSON, SHENIQUE (NP)
Entity Type:Individual
Prefix:
First Name:SHENIQUE
Middle Name:
Last Name:RANGER- HUTCHINSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHENIQUE
Other - Middle Name:
Other - Last Name:RANGER- HUTCHINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1847 MOTT AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4220
Mailing Address - Country:US
Mailing Address - Phone:718-337-6800
Mailing Address - Fax:
Practice Address - Street 1:1847 MOTT AVENUE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4200
Practice Address - Country:US
Practice Address - Phone:718-337-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402837-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health