MEDICARE: MISS SHIRLEY AMISSAH FNP

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	363LF0000X	Family Nurse Practitioner	337020	NY

General Provider Information

NPI Number	:	1487821773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHIRLEY AMISSAH FNP

Provider Business Mailing Address
First Line	:	899 NEWTON AVE
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-2826
Country	:	US
Telephone Number	:	917-676-2146
Fax Number	:

Provider Business Practice Location Address
First Line	:	899 NEWTON AVE
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-2826
Country	:	US
Telephone Number	:	917-676-2146
Fax Number	:

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

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	04/21/2015

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