Healthcare Provider Details

I. General information

NPI: 1871354423
Provider Name (Legal Business Name): EFFIE DISSTON SHILHAN DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 E BOSTON POST RD STE 201A
MAMARONECK NY
10543-3704
US

IV. Provider business mailing address

243 W 72ND ST APT 2
NEW YORK NY
10023-2704
US

V. Phone/Fax

Practice location:
  • Phone: 914-834-1777
  • Fax:
Mailing address:
  • Phone: 978-303-5181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number352016
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: