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NPI Code Detail

MEDICARE: LILA SHAMS AGNP-C

MEDICARE: LILA SHAMS AGNP-C
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
1163W00000XRegistered Nurse599715NY
2363LG0600XGerontology Nurse PractitionerF307201NY

General Provider Information

NPI Number : 1417213679
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILA SHAMS AGNP-C
Provider Business Mailing Address
First Line : 11 FRANKLIN PLACE
Second Line :
City : WOODMERE
State : NY
Zip : 11598
Country : US
Telephone Number : 516-569-0776
Fax Number : 516-569-0374
Provider Business Practice Location Address
First Line : 11 FRANKLIN PL
Second Line :
City : WOODMERE
State : NY
Zip : 11598-1216
Country : US
Telephone Number : 516-569-0776
Fax Number : 516-791-3775
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2012
Last Update Date : 07/21/2022

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