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Individual

JUSTIN WILLIAM SHAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP-P, PMHNP-BC

Contact information

Practice address
3425 VERNON BLVD, LONG ISLAND CITY, NY 11106-5121
(917) 575-5662
Mailing address
263 FRANKLIN AVE APT 1B, BROOKLYN, NY 11205-3554
(917) 575-5662

Taxonomy

Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
711620
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
403664
NY

Other

Enumeration date
10/25/2017
Last updated
12/28/2021
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