Provider Demographics
NPI:1821330713
Name:SHENK, KRISTINA SUZANNE (MD)
Entity Type:Individual
Prefix:MISS
First Name:KRISTINA
Middle Name:SUZANNE
Last Name:SHENK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1184 5TH AVE
Mailing Address - Street 2:KRAVIS CHILDREN'S HOSPITAL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6503
Mailing Address - Country:US
Mailing Address - Phone:614-946-1231
Mailing Address - Fax:
Practice Address - Street 1:333 15TH ST FL 2
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-3429
Practice Address - Country:US
Practice Address - Phone:201-482-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA10108000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program