Healthcare Provider Details

I. General information

NPI: 1245533389
Provider Name (Legal Business Name): KATHERINE SHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2010
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 E 92ND ST 2
NEW YORK NY
10128-0622
US

IV. Provider business mailing address

27 E 92ND ST APT 2
NEW YORK NY
10128-0622
US

V. Phone/Fax

Practice location:
  • Phone: 203-561-9835
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number576202
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF382164
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: