Provider Demographics
NPI:1326552258
Name:GRIFFITH-HAREWOOD, SHEALTIEAL V (NP)
Entity Type:Individual
Prefix:
First Name:SHEALTIEAL
Middle Name:V
Last Name:GRIFFITH-HAREWOOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14524 230TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3927
Mailing Address - Country:US
Mailing Address - Phone:718-712-6886
Mailing Address - Fax:718-712-2346
Practice Address - Street 1:14524 230TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-3927
Practice Address - Country:US
Practice Address - Phone:718-712-6886
Practice Address - Fax:718-712-2346
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily