Individual
MS. SHANICE ALICIA BANCROFT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
271 WAINWRIGHT ST, NEWARK, NJ 07112-3073
(347) 712-8636
Mailing address
271 WAINWRIGHT ST, NEWARK, NJ 07112-3073
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
40QB00391200
NJ
Other
Enumeration date
12/27/2021
Last updated
12/27/2021
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