Healthcare Provider Details

I. General information

NPI: 1144524679
Provider Name (Legal Business Name): MIRIAM LYDIA SHIFERAW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2010
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE ROSENTHAL 4
BRONX NY
10467-2403
US

IV. Provider business mailing address

375 AVALON GARDENS DR
NANUET NY
10954-7429
US

V. Phone/Fax

Practice location:
  • Phone: 202-460-1480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number257811
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: