Provider Demographics
NPI:1114219011
Name:ALLY, SHIRINA
Entity Type:Individual
Prefix:MISS
First Name:SHIRINA
Middle Name:
Last Name:ALLY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHIRINA
Other - Middle Name:
Other - Last Name:ALLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:11568 225TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1235
Mailing Address - Country:US
Mailing Address - Phone:718-341-0502
Mailing Address - Fax:
Practice Address - Street 1:11568 225TH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1235
Practice Address - Country:US
Practice Address - Phone:718-341-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639106-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse