Individual
SHELBY DANIELLE ALEXA-DIZARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM/WHNP, RN
Contact information
Practice address
136 LAKE ST STE 11, NEWBURGH, NY 12550-5245
(845) 562-7800
Mailing address
86 SHERIDAN RD, SCARSDALE, NY 10583-1553
(734) 972-7686
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
685729
NY
176B00000X
Midwife
F001920
NY
363LW0102X
Women's Health Nurse Practitioner
Primary
421498
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001920
CNM
NY
01
—
421498
WHNP LICENSE
NY
Enumeration date
06/05/2019
Last updated
02/01/2024
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