Kiewanda Shabazz-Henry, RN

Primary specialty

General Practice Registered NurseTaxonomy code 163WG0000X

License

26NO11517600 Issued in NY

Practice address

432 Bergen St
Harrison, NJ 07029-2291

Phone

(973) 493-5336

NPI assigned

Jun 29, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1649840984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "432 BERGEN ST",
            "city": "HARRISON",
            "state": "NJ",
            "postal_code": "070292291",
            "telephone_number": "973-483-5336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "432 BERGEN ST",
            "city": "HARRISON",
            "state": "NJ",
            "postal_code": "070292291",
            "telephone_number": "973-493-5336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHABAZZ-HENRY",
        "first_name": "KIEWANDA",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-29",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "NY",
            "license": "26NO11517600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Registered Nurse in Harrison, NJ
• Providers in Harrison, NJ by specialty
• General Practice Registered Nurse in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.