Healthcare Provider Details

I. General information

NPI: 1356039424
Provider Name (Legal Business Name): SHIRLEY D VINCENT DNP FAMILY HEALTH NP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TARGEE ST APT 2K
STATEN ISLAND NY
10304-4466
US

IV. Provider business mailing address

PO BOX 40964
STATEN ISLAND NY
10304-0964
US

V. Phone/Fax

Practice location:
  • Phone: 917-415-3215
  • Fax:
Mailing address:
  • Phone: 917-415-3215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY VINCENT
Title or Position: FAMILY NURSE PRACTITIONER
Credential: DNP, FNP-BC
Phone: 917-415-3215