Healthcare Provider Details

I. General information

NPI: 1306530522
Provider Name (Legal Business Name): SHIR WARR NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHIR WARR NBC-HWC

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 OLD KINGS RD
AVON CT
06001-2300
US

IV. Provider business mailing address

17 OLD KINGS RD
AVON CT
06001-2300
US

V. Phone/Fax

Practice location:
  • Phone: 646-298-7013
  • Fax:
Mailing address:
  • Phone: 646-298-7013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberSTUDENT
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3715230
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: