Healthcare Provider Details

I. General information

NPI: 1952452120
Provider Name (Legal Business Name): NANCY MAE SHAMBAN RN, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 WASHINGTON PL SUITE C
NEW YORK NY
10014-3837
US

IV. Provider business mailing address

119 WASHINGTON PL SUITE C
NEW YORK NY
10014-3837
US

V. Phone/Fax

Practice location:
  • Phone: 212-242-6935
  • Fax: 212-242-6935
Mailing address:
  • Phone: 212-242-6935
  • Fax: 212-242-6935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000452
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number190078
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: