Provider Demographics
NPI:1588759351
Name:DEVLIN, SHIMANE (NP)
Entity type:Individual
Prefix:MS
First Name:SHIMANE
Middle Name:
Last Name:DEVLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 JENNIFER CT
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-2714
Mailing Address - Country:US
Mailing Address - Phone:631-875-5350
Mailing Address - Fax:585-504-0083
Practice Address - Street 1:547 S COUNTRY RD
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-5546
Practice Address - Country:US
Practice Address - Phone:631-875-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401002 1363L00000X
NYF4010021363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner