MEDICARE: SHIRLEY AVA MCLAMORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	130626467	NY

General Provider Information

NPI Number	:	1316372311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY AVA MCLAMORE

Provider Business Mailing Address
First Line	:	11596 223RD ST
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11596 223RD ST
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1231
Country	:	US
Telephone Number	:	347-395-8666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2013
Last Update Date	:	09/09/2013

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Directions to “ SHIRLEY AVA MCLAMORE ” Practice Location

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