Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | F431179-1 | NY |
NPI | 1033638432 |
---|---|
Provider Name | Beena Shibu |
First Address | New York, NY 10032-3725 |
Second Address | New York, NY 10032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2017 |
Last Update Date | 14/05/2018 |