Healthcare Provider Details

I. General information

NPI: 1487280574
Provider Name (Legal Business Name): SHAIRA COHEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MAPLE ST
NORWALK CT
06850-3815
US

IV. Provider business mailing address

34 MAPLE ST
NORWALK CT
06850-3815
US

V. Phone/Fax

Practice location:
  • Phone: 203-845-4811
  • Fax: 203-899-5096
Mailing address:
  • Phone: 203-845-4811
  • Fax: 203-899-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8692
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: