Healthcare Provider Details

I. General information

NPI: 1144671934
Provider Name (Legal Business Name): IMAN SHIRELLE HINES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

487 S BROADWAY # 220
YONKERS NY
10705-3269
US

IV. Provider business mailing address

845 N BROADWAY
WHITE PLAINS NY
10603-2427
US

V. Phone/Fax

Practice location:
  • Phone: 914-423-4433
  • Fax: 914-423-9434
Mailing address:
  • Phone: 914-761-0600
  • Fax: 914-761-5367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number689982
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402597
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: