Healthcare Provider Details

I. General information

NPI: 1861692287
Provider Name (Legal Business Name): ALLA ADI SHABTAI RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CREEK LN
BRISTOL RI
02809-2401
US

IV. Provider business mailing address

1042 SOUTHERN BLVD
BRONX NY
10459-3406
US

V. Phone/Fax

Practice location:
  • Phone: 718-964-6161
  • Fax:
Mailing address:
  • Phone: 718-542-0200
  • Fax: 718-542-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011844
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: