Provider Demographics
NPI:1669256830
Name:BYNES, SHAWNNASIA NEKIA
Entity type:Individual
Prefix:MRS
First Name:SHAWNNASIA
Middle Name:NEKIA
Last Name:BYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAWNNASIA
Other - Middle Name:NEKIA
Other - Last Name:FLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4419 ROCKAWAY BEACH BLVD APT 5A
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1246
Mailing Address - Country:US
Mailing Address - Phone:917-432-4769
Mailing Address - Fax:
Practice Address - Street 1:253 W 35TH ST FL 16
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1907
Practice Address - Country:US
Practice Address - Phone:718-728-8476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist