Healthcare Provider Details

I. General information

NPI: 1386385854
Provider Name (Legal Business Name): MS. SHURLAND D GUMBS-NOEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 CASTLETON AVE
STATEN ISLAND NY
10310-1822
US

IV. Provider business mailing address

690 CASTLETON AVE
STATEN ISLAND NY
10310-1822
US

V. Phone/Fax

Practice location:
  • Phone: 718-876-3900
  • Fax:
Mailing address:
  • Phone: 718-876-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: