Provider Demographics
NPI:1265112395
Name:SHIN, HAERHAM (APRN)
Entity type:Individual
Prefix:
First Name:HAERHAM
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:RAIMY
Other - Middle Name:
Other - Last Name:SHIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:708 ORANGE ST APT 5
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2570
Mailing Address - Country:US
Mailing Address - Phone:202-893-4232
Mailing Address - Fax:
Practice Address - Street 1:55 LOCK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3603
Practice Address - Country:US
Practice Address - Phone:203-432-0038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT172971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily