Healthcare Provider Details

I. General information

NPI: 1881086601
Provider Name (Legal Business Name): SHIRA L ZAGURI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 BROADWAY RM 1505
NEW YORK NY
10007-1861
US

IV. Provider business mailing address

291 BROADWAY RM 1505
NEW YORK NY
10007-1861
US

V. Phone/Fax

Practice location:
  • Phone: 917-727-6546
  • Fax:
Mailing address:
  • Phone: 917-727-6546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number094016
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088835
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: