Healthcare Provider Details

I. General information

NPI: 1821232620
Provider Name (Legal Business Name): DEBORAH SHIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W 77TH ST
NEW YORK NY
10024-5116
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 212-579-6000
  • Fax: 212-579-3687
Mailing address:
  • Phone: 858-554-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC133069
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number252807
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: