Individual
MS. BLANDINE CLESIDOR SHACKLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6424 18TH AVE, BROOKLYN, NY 11204-3729
(212) 687-7464
Mailing address
6424 18TH AVE, BROOKLYN, NY 11204-3729
(212) 687-7464
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
756438
NY
164W00000X
Licensed Practical Nurse
2998881
NY
Other
Enumeration date
05/24/2010
Last updated
03/30/2022
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