Provider Demographics
NPI:1588706220
Name:SHAKES, RUDOLPH WESLEY (FNP)
Entity type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:WESLEY
Last Name:SHAKES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ELMHURST HOSPITAL CENTER
Mailing Address - Street 2:7901 BROADWAY, RM. D6-4
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1329
Mailing Address - Country:US
Mailing Address - Phone:718-334-4000
Mailing Address - Fax:
Practice Address - Street 1:HEALTH SERVICE AT COLUMBIA
Practice Address - Street 2:519 WEST 114TH STREET
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027
Practice Address - Country:US
Practice Address - Phone:212-854-9842
Practice Address - Fax:212-854-9851
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330610-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily