Provider Demographics
NPI:1306850656
Name:SHADLEN, MARIE-FLORENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE-FLORENCE
Middle Name:
Last Name:SHADLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIE-FLORENCE
Other - Middle Name:
Other - Last Name:WELLINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:346 21ST ST APT 1L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6453
Mailing Address - Country:US
Mailing Address - Phone:929-722-5520
Mailing Address - Fax:
Practice Address - Street 1:346 21ST ST APT 1L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6453
Practice Address - Country:US
Practice Address - Phone:929-722-5520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36296207QG0300X, 207R00000X, 207RH0002X
NY251746207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC362967Medicaid
NYFS1231745OtherDEA REGISTRATION NUMBER
WA121102Medicare ID - Type Unspecified
WAG18624Medicare UPIN