Individual
DR. STARR SHALAE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2627 HYLAN BLVD, STATEN ISLAND, NY 10306-4344
(646) 533-0990
Mailing address
1305 WALT WHITMAN RD STE 300, MELVILLE, NY 11747-4300
(516) 945-3000
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
345211
NY
207Q00000X
Family Medicine Physician
345211
NY
208VP0014X
Interventional Pain Medicine Physician
345211
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
663663
NY
Other
Enumeration date
02/28/2020
Last updated
02/17/2025
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