Provider Demographics
NPI:1073839742
Name:FRIDMAN, SHELLEY (RPA-C)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:FRIDMAN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 YORK AVE
Mailing Address - Street 2:BOX 124
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:212-639-7203
Mailing Address - Fax:212-717-3367
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:BOX 124
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:212-639-7203
Practice Address - Fax:212-717-3367
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013947363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant