Healthcare Provider Details

I. General information

NPI: 1033155155
Provider Name (Legal Business Name): SHIRLEY ESTHER ACKERMAN PH.D., CRRN-A, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 1ST AVE HCC-9
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

22 BROOKFIELD AVE
STATEN ISLAND NY
10308-2247
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-0572
  • Fax: 212-253-7476
Mailing address:
  • Phone: 212-263-0572
  • Fax: 212-263-7476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number354773-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number354773-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: