Healthcare Provider Details

I. General information

NPI: 1780927079
Provider Name (Legal Business Name): ANITA ELLIEEN SCHULTZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7559 263RD ST
GLEN OAKS NY
11004-1150
US

IV. Provider business mailing address

1051 PORT WASHINGTON BLVD UNIT 1216
PORT WASHINGTON NY
11050-0199
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-5780
  • Fax:
Mailing address:
  • Phone: 347-992-9275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404394
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number606829
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number606829
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: