MEDICARE: SHIRLEY DESRAMEAUX RN

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	7432521	NY

General Provider Information

NPI Number	:	1912465196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY DESRAMEAUX RN

Provider Business Mailing Address
First Line	:	45 MARTENSE ST APT 1K
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3271
Country	:	US
Telephone Number	:	347-500-9625
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 MARTENSE ST APT 1K
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3271
Country	:	US
Telephone Number	:	347-500-9625
Fax Number	:

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

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	03/07/2019

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