Healthcare Provider Details

I. General information

NPI: 1659326502
Provider Name (Legal Business Name): SHIVANI B NAZARETH M.S., CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E 61ST ST 8TH FLOOR
NEW YORK NY
10021-8722
US

IV. Provider business mailing address

425 E 61ST ST 8TH FLOOR
NEW YORK NY
10021-8722
US

V. Phone/Fax

Practice location:
  • Phone: 212-821-0830
  • Fax: 212-821-0832
Mailing address:
  • Phone: 212-821-0830
  • Fax: 212-821-0832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number2002024
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: