Healthcare Provider Details

I. General information

NPI: 1003290396
Provider Name (Legal Business Name): SHEILA A KERN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8268 164TH ST ROOM A531
JAMAICA NY
11432-1121
US

IV. Provider business mailing address

82-68 164TH STREET QUEENS HOSPITAL CENTER
JAMAICA NY
11432
US

V. Phone/Fax

Practice location:
  • Phone: 718-883-4133
  • Fax:
Mailing address:
  • Phone: 718-883-4133
  • Fax: 718-883-6295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number018687-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: