Provider Demographics
NPI:1295836146
Name:SHIR, IRENE (PA)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:
Last Name:SHIR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 NEPTUNE AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4540
Mailing Address - Country:US
Mailing Address - Phone:917-747-9595
Mailing Address - Fax:
Practice Address - Street 1:2900 N MILITARY TRL STE 107
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6347
Practice Address - Country:US
Practice Address - Phone:917-747-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010161363A00000X
FLPA9114690363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NYQ29792Medicare UPIN
NY00246075Medicaid