Healthcare Provider Details

I. General information

NPI: 1104016823
Provider Name (Legal Business Name): SHEILA NOLAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE SUITE 1400
HAWTHORNE NY
10532-2144
US

IV. Provider business mailing address

19 BRADHURST AVE SUITE 1400
HAWTHORNE NY
10532-2144
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-8333
  • Fax: 914-594-4366
Mailing address:
  • Phone: 914-493-8333
  • Fax: 914-594-4366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number267706
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberMD428132
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: