Provider Demographics
NPI:1245456607
Name:SCOTT, SHAMEEKA PETRILL (LPN)
Entity type:Individual
Prefix:MS
First Name:SHAMEEKA
Middle Name:PETRILL
Last Name:SCOTT
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 1:623 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-4223
Mailing Address - Country:US
Mailing Address - Phone:201-332-8190
Mailing Address - Fax:
Practice Address - Street 1:500 8TH AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-6504
Practice Address - Country:US
Practice Address - Phone:212-904-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse