Healthcare Provider Details

I. General information

NPI: 1336557941
Provider Name (Legal Business Name): ERIN M SHINDLE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 TILDEN ST
BRONX NY
10467-6013
US

IV. Provider business mailing address

2785 BROADWAY APT 6I
NEW YORK NY
10025-2845
US

V. Phone/Fax

Practice location:
  • Phone: 718-231-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401778
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: