Provider Demographics
NPI:1104016823
Name:NOLAN, SHEILA (MD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2144
Mailing Address - Country:US
Mailing Address - Phone:914-493-8333
Mailing Address - Fax:914-594-4366
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:SUITE 1400
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2144
Practice Address - Country:US
Practice Address - Phone:914-493-8333
Practice Address - Fax:914-594-4366
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2677062080P0201X
PAMD4281322080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03120692Medicaid
NYA400084747OtherMEDICARE PTAN
NYA400084748OtherMEDICARE PTAN