Healthcare Provider Details

I. General information

NPI: 1285049155
Provider Name (Legal Business Name): SHIRLEY CANDELARIO RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 WEST 157TH STREET
NEW YORK NY
10032-5058
US

IV. Provider business mailing address

44 W 28TH ST FL 5
NEW YORK NY
10001-4212
US

V. Phone/Fax

Practice location:
  • Phone: 212-781-7979
  • Fax: 212-781-7963
Mailing address:
  • Phone: 212-545-2409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number681959
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF341548-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: