Shaquan Jackson

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

342121 Issued in NY

Practice address

214 Saint Patrick Dr
Rochester, NY 14623-3730

Phone

(585) 615-4905

NPI assigned

Jun 7, 2022

Last updated

Jun 7, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654560000000",
    "number": "1730818691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 SAINT PATRICK DR",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146233730",
            "telephone_number": "585-615-4905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 SAINT PATRICK DR",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146233730",
            "telephone_number": "585-615-4905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHAQUAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-07",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "342121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natasha Ann Jackson
• Nicole Denise Jackson, LPN
• Quiana Jackson
• Rebecca Jackson, AU.D., CCC-A
• Shalana Venice Jackson, RN
• Shawnte Deon Jackson, LPN
• Tony Jackson
• Tori Jackson
• Tracey Monique Jackson, RN
• Vanessa Jackson, LPN

• Licensed Practical Nurse in Rochester, NY
• Providers in Rochester, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2022; 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.