Most Relevant Information
Provider Data
| NPI Number: | 1003469164 |
| Provider Name: | SHIVELL GARDENER |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/18/2019 |
| Last Updated: | 07/18/2019 |
Provider Practice Location
55 W AMES CT STE 100
PLAINVIEW
NY
118032304
Practice Location Phone/Fax
| Phone: | 5168226111 |
| Fax: |
Provider Mailing Location
55 W AMES CT STE 100
PLAINVIEW
NY
118032304
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |