Starr Shalae Jackson, is a
Family Medicine based in Staten Island, New York. Starr Shalae Jackson is licensed to practice in New York (license number 345211) and her current practice location is
2627 Hylan Blvd, Staten Island, New York. She can be reached at her office (for appointments etc.) via phone at
(646) 533-0990.
NPI number for Starr Shalae Jackson is 1578197588 and her current mailing address is 333 Lake Ave, Staten Island, New York. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1578197588.
Provider's Profile
| Full Name | Starr Shalae Jackson |
|---|
| Gender | Female |
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| Speciality | Family Medicine |
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| Location | 2627 Hylan Blvd, Staten Island, New York |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1578197588
- Provider Enumeration Date: 02/28/2020
- Last Update Date: 02/28/2020
Medical Identifiers
Medical identifiers for Starr Shalae Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1578197588 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 163WG0000X | Registered Nurse - General Practice | 345211 (New York) | Secondary |
| 208VP0014X | Pain Medicine - Interventional Pain Medicine | 345211 (New York) | Secondary |
| 207Q00000X | Family Medicine | 345211 (New York) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Starr Shalae Jackson is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Starr Shalae Jackson,
333 Lake Ave,
Staten Island, NY 10303-2628
Ph: () - | Starr Shalae Jackson,
2627 Hylan Blvd,
Staten Island, NY 10306-4344
Ph: (646) 533-0990 |
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