Provider Demographics
NPI:1710300561
Name:SHALIAN, ANNIE A (FNP)
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:A
Last Name:SHALIAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:A
Other - Last Name:SHALIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:53 FIELD TER
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-2609
Mailing Address - Country:US
Mailing Address - Phone:914-478-1898
Mailing Address - Fax:914-478-1898
Practice Address - Street 1:53 FIELD TER
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-2609
Practice Address - Country:US
Practice Address - Phone:914-478-1898
Practice Address - Fax:914-478-1898
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY567648-1163W00000X
NYF341600-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse