Healthcare Provider Details

I. General information

NPI: 1255235941
Provider Name (Legal Business Name): SHIRA ANTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13744 71ST AVE
FLUSHING NY
11367-1939
US

IV. Provider business mailing address

13744 71ST AVE
FLUSHING NY
11367-1939
US

V. Phone/Fax

Practice location:
  • Phone: 786-667-2627
  • Fax:
Mailing address:
  • Phone: 786-667-2627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number827609-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: