Provider Demographics
NPI:1184977720
Name:FELL, SHAKOYA M (LPN)
Entity type:Individual
Prefix:
First Name:SHAKOYA
Middle Name:M
Last Name:FELL
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 1:5016 31ST AVE APT 5A
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1305
Mailing Address - Country:US
Mailing Address - Phone:347-330-5404
Mailing Address - Fax:
Practice Address - Street 1:5016 31ST AVE APT 5A
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-1305
Practice Address - Country:US
Practice Address - Phone:347-330-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311149-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse