Provider Demographics
NPI:1548560568
Name:SHUTES, RONALD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:SHUTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 GREENE AVE
Mailing Address - Street 2:APT 3C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-5915
Mailing Address - Country:US
Mailing Address - Phone:347-512-4117
Mailing Address - Fax:
Practice Address - Street 1:767 GREENE AVE
Practice Address - Street 2:APT 3C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-5915
Practice Address - Country:US
Practice Address - Phone:347-512-4117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY633973163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool