Provider Demographics
NPI:1043623796
Name:KOHANIM, SHIRIN (NP)
Entity Type:Individual
Prefix:
First Name:SHIRIN
Middle Name:
Last Name:KOHANIM
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 1:19 SCHENCK AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3613
Mailing Address - Country:US
Mailing Address - Phone:917-808-3196
Mailing Address - Fax:
Practice Address - Street 1:19 SCHENCK AVE APT 2D
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3613
Practice Address - Country:US
Practice Address - Phone:917-808-3196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY685362163WC1500X
NYF345171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health