Provider Demographics
NPI:1992515134
Name:MOORE, SHANI (LPN)
Entity type:Individual
Prefix:
First Name:SHANI
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 KISSENA BLVD APT 1C
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1515
Mailing Address - Country:US
Mailing Address - Phone:929-216-9627
Mailing Address - Fax:
Practice Address - Street 1:129 ROCKAWAY AVE # 1114
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5812
Practice Address - Country:US
Practice Address - Phone:929-216-9627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346778164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse