Healthcare Provider Details

I. General information

NPI: 1124322177
Provider Name (Legal Business Name): KATHERINE MARIE WOHLSTADTER MMS, RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE MARIA SHEA MMS, RPA-C

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 E 74TH ST FL 2
NEW YORK NY
10021-3309
US

IV. Provider business mailing address

226 50TH AVE APT 9B
LONG ISLAND CITY NY
11101-4522
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-3301
  • Fax: 212-737-4876
Mailing address:
  • Phone: 561-542-7641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number014370
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: