Individual
MR. SHANE DANIEL GALLAGHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
462 1ST AVE, NEW YORK, NY 10016-9196
(212) 562-4141
Mailing address
462 1ST AVE, NEW YORK, NY 10016-9196
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
703317
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402369
NY
Other
Enumeration date
07/18/2017
Last updated
07/03/2018
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