Provider Demographics
NPI:1073075206
Name:BALCELLS SHUM, TAILING T (RN)
Entity Type:Individual
Prefix:
First Name:TAILING
Middle Name:T
Last Name:BALCELLS SHUM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TAILING
Other - Middle Name:T
Other - Last Name:BALCELLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:21 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:772 E 233RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-3200
Practice Address - Country:US
Practice Address - Phone:347-843-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY767063163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse