Provider Demographics
NPI:1689090649
Name:GONZALEZ, SHAILYN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SHAILYN
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 KASS RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-4411
Mailing Address - Country:US
Mailing Address - Phone:631-748-4468
Mailing Address - Fax:
Practice Address - Street 1:29 HOSPITAL PLZ STE 501
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3602
Practice Address - Country:US
Practice Address - Phone:203-276-2321
Practice Address - Fax:203-276-2327
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015892363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant