Provider Demographics
NPI:1245894609
Name:SHAJI, LAILA (RN)
Entity type:Individual
Prefix:
First Name:LAILA
Middle Name:
Last Name:SHAJI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HARMON PL
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2803
Mailing Address - Country:US
Mailing Address - Phone:845-521-1147
Mailing Address - Fax:
Practice Address - Street 1:1 HARMON PL STE D
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2803
Practice Address - Country:US
Practice Address - Phone:845-362-3904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY574063-1163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical