Provider Demographics
NPI:1982983763
Name:AKHUEMOKHAN, SHELLY
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:AKHUEMOKHAN
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 1:27 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1530
Mailing Address - Country:US
Mailing Address - Phone:516-851-3652
Mailing Address - Fax:
Practice Address - Street 1:27 WARREN ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1530
Practice Address - Country:US
Practice Address - Phone:516-851-3652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305136164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse