- Practice location
- 6321 New Utrecht Ave, Brooklyn, NY 11219-5425
- Phone
- 212-687-7464
- Fax
- 212-257-7016
- Last updated
- November 18, 2016
Shady Bourham is a Licensed Practical Nurse based in Brooklyn, NY. Shady Bourham practices in Brooklyn, NY. The NPI Number for Shady Bourham is 1316480643 and holds a License No. 327253 (NY). The current practice location address for Shady Bourham is 6321 New Utrecht Ave, Brooklyn, NY 11219-5425 and can be reached out via phone at 212-687-7464 and via fax at 212-257-7016.
Provider Profile Details
- NPI Number
- 1316480643
- Provider Name
- Shady Bourham
- Provider Entity Type
- Individual
- Gender
- Male
- Address
- 6321 New Utrecht Ave, Brooklyn, NY 11219-5425
- Phone Number
- 212-687-7464
- Fax Number
- 212-257-7016
- Primary Taxonomy
- Licensed Practical Nurse · 164W00000X
- Sole Proprietor
- Yes
- Provider Enumeration Date
- November 18, 2016
- Last Update Date
- November 18, 2016
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 6321 New Utrecht Ave
Brooklyn, NY 11219-5425 - City
- Brooklyn
- State
- New York
- Zip
- 11219-5425
- Phone Number
- 212-687-7464
- Fax Number
- 212-257-7016
Provider Business Mailing Address Details
- Address
- 250 Central Ave
Apt215-B
Newark, NJ 07103-4201 - City
- Newark
- State
- NJ
- Zip
- 07103-4201
- Phone Number
- 203-252-8704
License Information
- License Number
- 327253
- License State
- NY
- Taxonomy
- Licensed Practical Nurse · 164W00000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Shady Bourham?
The NPI number of Shady Bourham is 1316480643. It was assigned on November 18, 2016 and is currently active in the NPPES registry.
What is the specialty of Shady Bourham?
Shady Bourham is registered under the primary taxonomy Licensed Practical Nurse (code 164W00000X), licensed in NY under license number 327253.
Where does Shady Bourham practice?
The practice location is 6321 New Utrecht Ave, Brooklyn, NY 11219-5425. The office can be reached at 212-687-7464 (phone) or 212-257-7016 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1316480643 directly on the NPPES registry website.