Provider Demographics
NPI:1164671954
Name:SHIN, NAKYUNG (MA)
Entity Type:Individual
Prefix:MS
First Name:NAKYUNG
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:KAY
Other - Middle Name:N
Other - Last Name:SHIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:325 E 64TH ST
Mailing Address - Street 2:APT. 209
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6709
Mailing Address - Country:US
Mailing Address - Phone:917-579-6629
Mailing Address - Fax:
Practice Address - Street 1:80 5TH AVE
Practice Address - Street 2:SUITE 903A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8002
Practice Address - Country:US
Practice Address - Phone:212-633-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001165221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist