Shameila Bacchus
Individual provider Active NPI Registered Nurse · Glen Head, NY
NPI 1962226704 · NPPES record last updated Nov 8, 2024
Key facts
- NPI
- 1962226704
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 642585 (NY)
- Practice address
- 4 Coolidge Ave
Glen Head, NY 11545-1506 - Phone
- (516) 343-0779
- NPI assigned
- Nov 8, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 642585 | NY | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 642585 | NY | Yes |
Addresses
Primary practice location
4 Coolidge Ave
Glen Head, NY 11545-1506
Mailing address
4 Coolidge Ave
Glen Head, NY 11545-1506
Phone (516) 343-0779
Other providers in Glen Head, NY
- Veronica Attina
- Federica Avantaggiato
- Joshua Axelrod
- Ayesha Assad Medical PLLC
- Mikhail Azernov
- Beth P. Bailey
- Lauren Renee Baker
- Mazhar Baker
- Meghan Anne Barker
- Barrtmenschddspc
All providers in Glen Head, NY · Registered Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.