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General NPI Number Information
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NPI Number | 1033552930
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Entity Type | Individual
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Provider Name | RACHEL SHIVELY M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 11/17/2017
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Provider Practice Location Address
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Address Line | 300 COMMUNITY DR
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City | MANHASSET
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State | NY
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Zip | 11030-3816
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Country | US
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Telephone | 847-567-4404
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Fax |
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Provider Business Mailing Address
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Address Line | 199 MONITOR ST APT FL1
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City | BROOKLYN
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State | NY
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Zip | 11222-3603
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Country | US
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Telephone | 847-567-4404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PT0002X
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Taxonomy Name | Medical Toxicology (Emergency Medicine) Physician
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License Number | 286686
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License Number State | NY
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