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General NPI Number Information
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NPI Number | 1861092009
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Entity Type | Individual
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Provider Name | SHIRIELLE TZIPORAH AVAKIAN NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 723 N BEERS ST
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City | HOLMDEL
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State | NJ
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Zip | 07733-1517
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Country | US
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Telephone | 908-601-0359
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Fax |
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Provider Business Mailing Address
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Address Line | 520 WAKEFIELD RD
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City | NEPTUNE
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State | NJ
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Zip | 07753-4235
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ010549000
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License Number State | NJ
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