Provider Demographics
NPI:1417213679
Name:SHAMS, LILA (AGNP-C)
Entity Type:Individual
Prefix:
First Name:LILA
Middle Name:
Last Name:SHAMS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FRANKLIN PLACE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598
Mailing Address - Country:US
Mailing Address - Phone:516-569-0776
Mailing Address - Fax:516-569-0374
Practice Address - Street 1:11 FRANKLIN PL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1216
Practice Address - Country:US
Practice Address - Phone:516-569-0776
Practice Address - Fax:516-791-3775
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY599715163W00000X
NYF307201363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse