Provider Demographics
NPI:1174754949
Name:MCINTYRE, SHERENE MONIFA (FNP)
Entity type:Individual
Prefix:
First Name:SHERENE
Middle Name:MONIFA
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 E 94TH ST
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1442
Mailing Address - Country:US
Mailing Address - Phone:718-926-5909
Mailing Address - Fax:718-221-5761
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:BOX 1274
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2056
Practice Address - Country:US
Practice Address - Phone:718-270-3064
Practice Address - Fax:718-221-5761
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335387363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily