Provider Demographics
NPI:1467261313
Name:LIGHTFOOT, SHATOY
Entity type:Individual
Prefix:
First Name:SHATOY
Middle Name:
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 MARCUS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1221
Mailing Address - Country:US
Mailing Address - Phone:516-224-2800
Mailing Address - Fax:
Practice Address - Street 1:1111 MARCUS AVE
Practice Address - Street 2:
Practice Address - City:NORTH NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1221
Practice Address - Country:US
Practice Address - Phone:516-224-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY355223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily