MEDICARE: SHANE VALERIE CURTIS DIEZ RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	N10553	NY

General Provider Information

NPI Number	:	1427987338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE VALERIE CURTIS DIEZ RN

Provider Business Mailing Address
First Line	:	1815 PUTNAM AVE APT A1
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-5475
Country	:	US
Telephone Number	:	220-241-0304
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 PUTNAM AVE APT A1
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-5475
Country	:	US
Telephone Number	:	220-241-0304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2026
Last Update Date	:	05/16/2026

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