Provider Demographics
NPI:1700027059
Name:SHUPE, HOMAIRA
Entity Type:Individual
Prefix:
First Name:HOMAIRA
Middle Name:
Last Name:SHUPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-4901
Mailing Address - Country:US
Mailing Address - Phone:631-395-0068
Mailing Address - Fax:
Practice Address - Street 1:11 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-4901
Practice Address - Country:US
Practice Address - Phone:631-395-0068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY496653163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse