Healthcare Provider Details

I. General information

NPI: 1174876759
Provider Name (Legal Business Name): NATALIA SHELLLIZA DIAZ MSN RN AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 WASHINGTON AVE
BROOKLYN NY
11205-3702
US

IV. Provider business mailing address

600 ABBOTT AVE
RIDGEFIELD NJ
07657-1706
US

V. Phone/Fax

Practice location:
  • Phone: 917-407-6790
  • Fax:
Mailing address:
  • Phone: 917-407-6790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number312765-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR16361200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number663077
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ15560500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: