Provider Demographics
NPI:1326495292
Name:KUMPILUVELY, SHAIMOLE JOSE
Entity Type:Individual
Prefix:
First Name:SHAIMOLE
Middle Name:JOSE
Last Name:KUMPILUVELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAIMOLE
Other - Middle Name:
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:31 REVERE RD
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1219
Mailing Address - Country:US
Mailing Address - Phone:914-592-7555
Mailing Address - Fax:
Practice Address - Street 1:31 REVERE RD
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1219
Practice Address - Country:US
Practice Address - Phone:914-592-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363LP0200X363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics