=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508986597
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHEILA ANNE MOLYNEAUX NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7559 263RD ST
-----------------------------------------------------
City | GLEN OAKS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11004-1150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-470-8082
-----------------------------------------------------
Fax | 718-831-0368
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 972 BRUSH HOLLOW RD
-----------------------------------------------------
City | WESTBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11590-1740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-876-5555
-----------------------------------------------------
Fax | 516-876-1246
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | F400135
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------