Provider Demographics
NPI:1164963948
Name:HATCHER, SHIRLEY J (MD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:J
Last Name:HATCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SHIRLEY
Other - Middle Name:J
Other - Last Name:HATCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1407 LINDEN BLVD
Mailing Address - Street 2:6F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-5154
Mailing Address - Country:US
Mailing Address - Phone:917-208-7314
Mailing Address - Fax:718-566-7863
Practice Address - Street 1:1407 LINDEN BLVD
Practice Address - Street 2:6F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5154
Practice Address - Country:US
Practice Address - Phone:917-208-7314
Practice Address - Fax:718-566-7863
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist