Provider Demographics
NPI:1457577157
Name:LINZ, SHEILA JUDY (NP)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:JUDY
Last Name:LINZ
Suffix:
Gender:F
Credentials:NP
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 493
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NJ
Mailing Address - Zip Code:08555-0493
Mailing Address - Country:US
Mailing Address - Phone:609-462-7311
Mailing Address - Fax:
Practice Address - Street 1:651 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3703
Practice Address - Country:US
Practice Address - Phone:212-740-1780
Practice Address - Fax:212-740-1743
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400654363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF400654Medicaid