| Doctor Name: | MISS MARGERY SHANE |
| NPI Number: | 1003172784 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | F.N.P. |
| License Number: | F337115-1 |
| Business Practice Address: | 347 Edison St Staten Island, NY - 103063034 |
| Business Phone Number: | 7183511136 |
| Business Fax Number: | 7186679711 |
| Mailing Address: | 97 New Dorp Ln, Suite A STATEN ISLAND |
| State: | NY |
| Postal Code: | 103062364 |
| Phone Number: | 7188766220 |
| Fax Number: | 7188765969 |
| NPI Enumeration Date: | 04/06/2012 |
| NPI Last Update Date: | 12/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F337115-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |