Healthcare Provider Details

I. General information

NPI: 1548423577
Provider Name (Legal Business Name): SHAWN MICHAEL ALLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VARICK ST PROJECT RENEWAL - 9TH FLOOR
NEW YORK NY
10014-4810
US

IV. Provider business mailing address

200 VARICK ST PROJECT RENEWAL - 9TH FLOOR
NEW YORK NY
10014-4810
US

V. Phone/Fax

Practice location:
  • Phone: 212-620-0340
  • Fax:
Mailing address:
  • Phone: 212-620-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number049018
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number265692
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: