Healthcare Provider Details

I. General information

NPI: 1518834514
Provider Name (Legal Business Name): JULIE SHIMONI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 W END AVE R10A
NEW YORK NY
10023-7853
US

IV. Provider business mailing address

75 W END AVE
NEW YORK NY
10023-7853
US

V. Phone/Fax

Practice location:
  • Phone: 631-790-4209
  • Fax:
Mailing address:
  • Phone: 631-790-4209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408796
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: