Individual
COLEEN SHAKLEFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3207 TENBROECK AVE, BRONX, NY 10469-5010
(347) 478-4037
Mailing address
3207 TENBROECK AVE, BRONX, NY 10469-5010
(347) 478-4037
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
316840
NY
Other
Enumeration date
11/07/2013
Last updated
11/07/2013
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