Provider Demographics
NPI:1396256525
Name:BI, SHELLEY Z (PA)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:Z
Last Name:BI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6776 BOOTH ST APT 4M
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3112
Mailing Address - Country:US
Mailing Address - Phone:347-279-7475
Mailing Address - Fax:
Practice Address - Street 1:945 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2661
Practice Address - Country:US
Practice Address - Phone:646-687-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58272363A00000X
NY021253363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant