1912355934 NPI number — SHAWNA SHEW-A-TJON

Table of content: SHAWNA SHEW-A-TJON (NPI 1912355934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912355934 NPI number — SHAWNA SHEW-A-TJON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEW-A-TJON
Provider First Name:
SHAWNA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912355934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
469 7TH AVE APT 2L
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07107-1168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-306-9543
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2336 ANDREWS AVE FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10468-6001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-561-5300
Provider Business Practice Location Address Fax Number:
718-561-6253
Provider Enumeration Date:
05/31/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 52-1923613 . This is a "NEW YORK CENTER FOR INFANTS AND TODDLERS, INC." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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