Healthcare Provider Details

I. General information

NPI: 1598685133
Provider Name (Legal Business Name): SHIRLEY ELIZABETH BRAITHWAITE-CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 BAY 25TH ST RM 106
FAR ROCKAWAY NY
11691-1800
US

IV. Provider business mailing address

75 COMMERCIAL ST
FREEPORT NY
11520-2833
US

V. Phone/Fax

Practice location:
  • Phone: 718-337-9441
  • Fax: 718-337-9442
Mailing address:
  • Phone: 718-337-9441
  • Fax: 718-337-9442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: