Healthcare Provider Details

I. General information

NPI: 1922100429
Provider Name (Legal Business Name): MR. SHAUN SCHULTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2057
US

IV. Provider business mailing address

143 NEWPORT ST
BROOKLYN NY
11212-5301
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-3908
  • Fax:
Mailing address:
  • Phone: 347-742-8267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number508615-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: