Basic Information
| Provider Information | |||||||||
| NPI: | 1437402419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARON | ||||||||
| FirstName: | SHANNA | ||||||||
| MiddleName: | LAUREN | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 LAKEVILLE RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110421101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163543401 | ||||||||
| FaxNumber: | 5163548597 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 LAKEVILLE RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110421101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163543401 | ||||||||
| FaxNumber: | 5163548597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2012 | ||||||||
| LastUpdateDate: | 11/01/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 337352 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.