Healthcare Provider Details

I. General information

NPI: 1528989001
Provider Name (Legal Business Name): WELLNESS FAMILY HEALTH NURSE PRACTITIONER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 HAMILTON AVENUE SUITE 6
WHITE PLAINS NY
10601
US

IV. Provider business mailing address

323 HONNESS RD
FISHKILL NY
12524-2983
US

V. Phone/Fax

Practice location:
  • Phone: 646-294-8884
  • Fax: 929-290-0328
Mailing address:
  • Phone: 646-294-8884
  • Fax: 929-290-0328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RONETTE SHAW
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 646-294-8884