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Deactivated NPI 1063668051 Deactivated / Inactive NPI Female Practitioner

Shiniece Nicole Jackson

Licensed Practical Nurse • Syracuse, NY

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Shiniece Jackson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date August 11, 2008
NPI Deactivation Date November 01, 2011
Total Practice Duration ~3 Years of Practice (2008 – 2011)

Professional Overview & Biography Verified Profile Summary

Shiniece Jackson was a registered Licensed Practical Nurse practicing in Syracuse, NY. Throughout an active medical career spanning 3 years, Shiniece Jackson provided care at the practice location at 5813 S SALINA ST until profile deactivation on 2011-11-01.

Practice Location & Contact Primary Location

Practice Address

5813 S Salina St

Syracuse, NY 132053264

Telephone 3153804864

Specialty Benchmarks & Practice Insights

Comparative analytics for Licensed Practical Nurse in Syracuse, NY

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 8.0 Yrs
Regional Practice Density
493 Specialists

Practicing in Syracuse, NY (23738 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2022-02-15
Licensed Practical Nurse Primary Specialty

NUCC Taxonomy Code: 164W00000X

State License NY 263257-1

An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
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Updated Practice Location February 15, 2022

Registered at 5813 S SALINA ST, SYRACUSE, NY 132053264 (Tel: 3153804864)

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Updated Business Mailing Address February 15, 2022

Registered at 5813 S SALINA ST, SYRACUSE, NY 132053264 (Tel: 3153804864)

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Provider Name / Credentials Updated February 15, 2022

Recorded as SHINIECE JACKSON

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Medical Taxonomy / Specialty Registered (Primary Specialty) February 15, 2022

Licensed Practical Nurse (License #263257-1 in NY)

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NPI Profile Deactivated November 01, 2011

Record deactivated on November 01, 2011

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Initial NPI Registration & Enumeration August 11, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1063668051
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 11, 2008
Last Update: February 15, 2022
Deactivation Date: November 01, 2011
Sole Proprietor: Yes

Mailing Address

5813 S Salina St

Syracuse, NY 132053264

Phone: 3153804864

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.