Healthcare Provider Details

I. General information

NPI: 1487870952
Provider Name (Legal Business Name): SHINAWE JIMENEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY, WOODHULL MEDICAL & MENTAL HEALTH CENTER DEPARTMENT OF PEDIATRICS
BROOKLYN NY
11206
US

IV. Provider business mailing address

760 BROADWAY, WOODHULL MEDICAL & MENTAL HEALTH CENTER DEPARTMENT OF PEDIATRICS ROOM 2B-321
BROOKLYN NY
11206
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-8000
  • Fax: 718-630-3122
Mailing address:
  • Phone: 718-963-8000
  • Fax: 718-630-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number241670
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: