Provider Demographics
NPI:1750690863
Name:IRBY, SHANI N (ANP-BC)
Entity type:Individual
Prefix:MS
First Name:SHANI
Middle Name:N
Last Name:IRBY
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31-72 31ST
Mailing Address - Street 2:2D
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106
Mailing Address - Country:US
Mailing Address - Phone:516-426-8160
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVENUE
Practice Address - Street 2:BMT CLINIC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:212-639-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305438-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner