Individual
SHANELLE TASHAE GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 HEALTHY WAY, OCEANSIDE, NY 11572-1551
(516) 632-3000
Mailing address
98 PERRY ST, HEMPSTEAD, NY 11550-5220
(347) 282-0528
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
20801
NY
Other
Enumeration date
07/31/2017
Last updated
07/31/2017
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