Provider Demographics
NPI:1396296919
Name:GROSS, SHIFFON
Entity type:Individual
Prefix:
First Name:SHIFFON
Middle Name:
Last Name:GROSS
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 1:1040 ROUTE 166 APT 1507
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-4156
Mailing Address - Country:US
Mailing Address - Phone:732-505-1550
Mailing Address - Fax:
Practice Address - Street 1:1040 ROUTE 166 APT 1507
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-4156
Practice Address - Country:US
Practice Address - Phone:732-505-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician