Individual
EMILY TREDGOLD SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
506 LENOX AVE, NEW YORK, NY 10037-1889
(000) 000-0000
Mailing address
506 LENOX AVE, NEW YORK, NY 10037-1889
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
658782
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
401786
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP08772
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08330271
—
MS
05
—
2422715
—
LA
Enumeration date
07/31/2014
Last updated
06/28/2018
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