Most Relevant Information
Provider Data
| NPI Number: | 1003206624 |
| Provider Name: | SHADONNA ADOFI BLAKE LPN |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 321286 |
Most Important Dates
| Enumeration Date: | 02/03/2015 |
| Last Updated: | 02/03/2015 |
Provider Practice Location
1424 MOTT AVE
FAR ROCKAWAY
NY
116915108
Practice Location Phone/Fax
| Phone: | 3477522926 |
| Fax: |
Provider Mailing Location
1424 MOTT AVE
FAR ROCKAWAY
NY
116915108
Provider Mailing Phone/Fax
| Phone: | 3477522926 |
| Fax: |