Provider Demographics
NPI:1760921647
Name:JOSEPH, SHIRLEY (APRN)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1892
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-8602
Mailing Address - Country:US
Mailing Address - Phone:203-687-5668
Mailing Address - Fax:860-489-2604
Practice Address - Street 1:1389 W MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3115
Practice Address - Country:US
Practice Address - Phone:203-687-5668
Practice Address - Fax:860-489-2604
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093616163W00000X
CT006959363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse