Provider Demographics
NPI:1841529781
Name:WHITE, SHAWNETTE ANGELEE (PA)
Entity type:Individual
Prefix:MS
First Name:SHAWNETTE
Middle Name:ANGELEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:385 REMSEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-1245
Mailing Address - Country:US
Mailing Address - Phone:347-915-1755
Mailing Address - Fax:347-915-1756
Practice Address - Street 1:385 REMSEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-1245
Practice Address - Country:US
Practice Address - Phone:347-915-1755
Practice Address - Fax:347-915-1756
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF304977-1363LA2200X
NY019447363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health