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Individual
SHAUNTELLE MARIE FARDEN
Active
Individual
SHAUNTELLE MARIE FARDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
702715
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00354485
—
NY
05
—
00914154
—
NY
05
—
01271109
—
NY
05
—
01414960
—
NY
05
—
02369919
—
NY
05
—
0271856
—
NY
01
—
70091A
MEDICARE ID TYPE UNSPECIFIED
NY
Enumeration date
06/29/2016
Last updated
06/29/2016
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