Provider Demographics
NPI:1457196305
Name:SIMPSON, SHANIQUE KENISHA
Entity type:Individual
Prefix:
First Name:SHANIQUE
Middle Name:KENISHA
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANIQUE
Other - Middle Name:KENISHA
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2711 PEARSALL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5322
Mailing Address - Country:US
Mailing Address - Phone:917-673-0408
Mailing Address - Fax:
Practice Address - Street 1:2711 PEARSALL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5322
Practice Address - Country:US
Practice Address - Phone:917-673-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY614178163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse