Provider Demographics
NPI:1972925410
Name:MCNICHOL, SHAKIMA O (RN-BSN)
Entity Type:Individual
Prefix:
First Name:SHAKIMA
Middle Name:O
Last Name:MCNICHOL
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 WESTCHESTER AVE STE N-230
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3522
Mailing Address - Country:US
Mailing Address - Phone:347-813-7677
Mailing Address - Fax:
Practice Address - Street 1:1133 WESTCHESTER AVE STE N-230
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3522
Practice Address - Country:US
Practice Address - Phone:347-813-7677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314428-1164W00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No164W00000XNursing Service ProvidersLicensed Practical Nurse