Healthcare Provider Details

I. General information

NPI: 1306850656
Provider Name (Legal Business Name): MARIE-FLORENCE SHADLEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIE-FLORENCE WELLINGTON M.D.

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 21ST ST APT 1L
BROOKLYN NY
11215-6453
US

IV. Provider business mailing address

346 21ST ST APT 1L
BROOKLYN NY
11215-6453
US

V. Phone/Fax

Practice location:
  • Phone: 929-722-5520
  • Fax:
Mailing address:
  • Phone: 929-722-5520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number36296
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36296
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number36296
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number251746
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: