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General NPI Number Information
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NPI Number | 1104587039
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Entity Type | Individual
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Provider Name | CHRISTINA SHAMROCK PA
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Gender | Female
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 635 MADISON AVE STE 1402E
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City | NEW YORK
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State | NY
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Zip | 10022-1009
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Country | US
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Telephone | 212-439-5177
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Fax |
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Provider Business Mailing Address
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Address Line | 99 TEANECK RD APT 312
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City | RIDGEFIELD PARK
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State | NJ
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Zip | 07660-2373
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Country | US
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Telephone | 917-941-2571
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 028024
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License Number State | NY
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