Healthcare Provider Details

I. General information

NPI: 1649130600
Provider Name (Legal Business Name): PHILLIPA SHAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DARROW PL APT 6E
BRONX NY
10475-1865
US

IV. Provider business mailing address

100 DARROW PL APT 6E
BRONX NY
10475-1865
US

V. Phone/Fax

Practice location:
  • Phone: 347-495-4784
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number742043
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: