Provider Demographics
NPI:1588422778
Name:SEBASTIAN, SHAKIRA JACQUELINE (APRN)
Entity type:Individual
Prefix:
First Name:SHAKIRA
Middle Name:JACQUELINE
Last Name:SEBASTIAN
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SCOFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-2928
Mailing Address - Country:US
Mailing Address - Phone:929-290-4044
Mailing Address - Fax:
Practice Address - Street 1:208 SCOFIELD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-2928
Practice Address - Country:US
Practice Address - Phone:929-290-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13166363LA2200X
NY2023166903363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health