MEDICARE: SHIRA BASS NP

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	163W00000X	Registered Nurse	677398-1	NY
2	363L00000X	Nurse Practitioner	F43175201	NY
3	363LA2200X	Adult Health Nurse Practitioner	F431752-01	NY
4	363L00000X	Nurse Practitioner	1084189	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	677398-1	OTHER	NY	LICENSE#

General Provider Information

NPI Number	:	1396140893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRA BASS NP

Provider Business Mailing Address
First Line	:	5303 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-7208
Country	:	US
Telephone Number	:	917-327-8453
Fax Number	:

Provider Business Practice Location Address
First Line	:	5303 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-6338
Country	:	US
Telephone Number	:	917-327-8453
Fax Number	:

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

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	06/12/2025

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Directions to “ SHIRA BASS NP” Practice Location

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