Provider Demographics
NPI:1215413067
Name:SHEK, IVY (CRNA)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:SHEK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CATHARINE STREET, P.O. BOX 550
Mailing Address - Street 2:PARK SLOPE ANESTHESIA ASSOCIATES, PC
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12602
Mailing Address - Country:US
Mailing Address - Phone:866-868-8416
Mailing Address - Fax:845-790-2675
Practice Address - Street 1:506 6TH STREET
Practice Address - Street 2:NY METHODIST HOSPITAL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-780-3279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY576394-1163W00000X, 367500000X
NJ26NR13659700163WC0200X
NY123656367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine