Healthcare Provider Details

I. General information

NPI: 1447792817
Provider Name (Legal Business Name): MS. SHEILA JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 CLARKSON AVE
BROOKLYN NY
11203-2199
US

IV. Provider business mailing address

681 CLARKSON AVE
BROOKLYN NY
11203-2199
US

V. Phone/Fax

Practice location:
  • Phone: 718-221-7499
  • Fax:
Mailing address:
  • Phone: 718-221-7499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number723674-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: