Provider Demographics
NPI:1841701513
Name:WHITE, SHALIESHIA SENEA (RN)
Entity type:Individual
Prefix:MS
First Name:SHALIESHIA
Middle Name:SENEA
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHALIESHIA
Other - Middle Name:SENEA
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-0839
Mailing Address - Country:US
Mailing Address - Phone:631-880-9547
Mailing Address - Fax:
Practice Address - Street 1:24 TYLER ST UNIT 1
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-9793
Practice Address - Country:US
Practice Address - Phone:631-880-9547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY739520-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9882501OtherNY OFFICE OF PROFESSIONS