Basic Information
| Provider Information | |||||||||
| NPI: | 1962856328 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LABORDE | ||||||||
| FirstName: | SHANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3198 GRAND CONCOURSE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104581000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186180401 | ||||||||
| FaxNumber: | 7187954394 | ||||||||
| Practice Location | |||||||||
| Address1: | 1265 FULTON AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104563401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185797000 | ||||||||
| FaxNumber: | 7182996797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2016 | ||||||||
| LastUpdateDate: | 05/04/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | P01015 | NY | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.