Individual
SHANAVA GEDEON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2054 TILLOTSON AVE, BRONX, NY 10475-1560
(718) 671-2100
Mailing address
2054 TILLOTSON AVE, BRONX, NY 10475-1560
(718) 671-2100
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
311730
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
14687
CT
Other
Enumeration date
11/15/2012
Last updated
05/20/2025
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