Provider Demographics
NPI:1033155155
Name:ACKERMAN, SHIRLEY ESTHER (PHD, CRRN-A, CDE)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ESTHER
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:PHD, CRRN-A, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BROOKFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2247
Mailing Address - Country:US
Mailing Address - Phone:212-263-0572
Mailing Address - Fax:212-263-7476
Practice Address - Street 1:530 1ST AVE
Practice Address - Street 2:HCC-9
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-0572
Practice Address - Fax:212-253-7476
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY354773-1163WD0400X, 163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Not Answered163WR0400XNursing Service ProvidersRegistered NurseRehabilitation