Provider Demographics
NPI:1720625551
Name:WHITE-MCGUIRE, SHANA KATHLEEN (NP)
Entity Type:Individual
Prefix:MS
First Name:SHANA
Middle Name:KATHLEEN
Last Name:WHITE-MCGUIRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SHANA
Other - Middle Name:KATHLEEN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP, RN
Mailing Address - Street 1:50 OVERLOOK TER APT 6F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-2210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11050 71ST RD STE 1B
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4929
Practice Address - Country:US
Practice Address - Phone:718-268-1458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309009363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health