Provider Demographics
NPI:1609010537
Name:KABLAN, SHIRLEY K (NP)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:K
Last Name:KABLAN
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 1:837 PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-2817
Mailing Address - Country:US
Mailing Address - Phone:917-365-4948
Mailing Address - Fax:
Practice Address - Street 1:837 PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-2817
Practice Address - Country:US
Practice Address - Phone:718-602-4188
Practice Address - Fax:718-602-4124
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420510-1363LW0102X
NYF001637-1176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health