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General NPI Number Information
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NPI Number | 1851581573
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Entity Type | Individual
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Provider Name | BETHANY R SHANKU PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 157 REMSEN ST
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City | BROOKLYN
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State | NY
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Zip | 11201-4321
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Country | US
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Telephone | 718-260-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 157 REMSEN ST
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City | BROOKLYN
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State | NY
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Zip | 11201-4321
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Country | US
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Telephone | 718-260-1000
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1507
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0796
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 015254
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License Number State | NY
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