Provider Information for 1508490889
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SHANNON RICK
Sex: Female
NPI: 1508490889
Last Updated: 2020-02-26
Certification Date: 2020-02-26
Certification Date: 2020-02-26
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1508490889 | ||||||||
| Enumeration Date | 2020-02-26 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1688 VICTORY BLVD STATEN ISLAND, NY 10314-3547 United States Phone: 718-447-5700 | Fax: | ||||||||
| Primary Practice Address | 1688 VICTORY BLVD STATEN ISLAND, NY 10314-3547 United States Phone: 718-447-5700 | Fax: | ||||||||
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