Individual
MS. HEIDI SHORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
5000 AVENUE K, BROOKLYN, NY 11234
(718) 968-1515
(718) 209-2295
Mailing address
244 96 61 AVENUE DOUGLASTON NY 11362, DOUGLASTON, NY 11362
(718) 968-1515
(718) 209-2295
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
002629
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00203892
—
NY
Enumeration date
09/20/2006
Last updated
07/08/2007
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