Provider Demographics
NPI:1588972145
Name:O'BRIAN, SHANEEZA (NP)
Entity type:Individual
Prefix:MRS
First Name:SHANEEZA
Middle Name:
Last Name:O'BRIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 WILLIAMSBRIDGE RD FL 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2507
Mailing Address - Country:US
Mailing Address - Phone:718-618-0401
Mailing Address - Fax:347-479-1303
Practice Address - Street 1:2182 PITKIN AVE FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-3613
Practice Address - Country:US
Practice Address - Phone:718-571-9177
Practice Address - Fax:718-571-9178
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY618403163W00000X
NYF338432-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN290917OtherREGISTERED PROFESSIONAL NURSE
CA95218638OtherRN
FLAPRN9449582OtherCERTIFIED NP
NJ26NR21296400OtherREGISTERED PROFESSIONAL NURSE
FLRN9449582OtherRN
NY618403OtherREGISTERED PROFESSIONAL NURSE
NY618403OtherREGISTERED PROFESSIONAL NURSE