Individual
SHANAE JONELL LUCES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-5731
Mailing address
80 GREENWAY TER, MIDDLETOWN, NY 10941-1638
(845) 820-6062
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
02/04/2025
Last updated
02/04/2025
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