Provider Demographics
NPI:1275986549
Name:CHARLES, SHIRLEY (EDD)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 NOSTRAND AVE APT 1G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3719
Mailing Address - Country:US
Mailing Address - Phone:347-312-4455
Mailing Address - Fax:
Practice Address - Street 1:3315 NOSTRAND AVE APT 1G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3719
Practice Address - Country:US
Practice Address - Phone:347-312-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist