Healthcare Provider Details

I. General information

NPI: 1750183877
Provider Name (Legal Business Name): SHIELA MOFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE
ALBANY NY
12208-3478
US

IV. Provider business mailing address

5 BROOM SHOP LN APT 201
LATHAM NY
12110-2283
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-3125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number699560-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: