Provider Demographics
NPI:1164748620
Name:CORTES, SHIRLEY AMANDA
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:AMANDA
Last Name:CORTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 LOMBARD ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1672
Mailing Address - Country:US
Mailing Address - Phone:609-602-1881
Mailing Address - Fax:
Practice Address - Street 1:1436 LOMBARD ST APT 3R
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1672
Practice Address - Country:US
Practice Address - Phone:609-602-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program