Individual provider Active NPI

Shirley Yu Chan, RN, BSN, CDE

  • Diabetes Educator Registered Nurse
  • New York, NY
National Provider Identifier
1699030593
Registry record updated Jul 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diabetes Educator Registered NurseTaxonomy code 163WD0400X
License
493224 Issued in NY
Practice address
376 Broadway
Apt 14a
New York, NY 10013-3940
Phone
(212) 227-9619
NPI assigned
Jul 7, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 7, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diabetes Educator Registered Nurse 163WD0400X 493224 NY Primary

Addresses

Primary practice location

376 Broadway
Apt 14a
New York, NY 10013-3940

Mailing address

376 Broadway
# 14A
New York, NY 10013-3940
Phone (212) 227-9619

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Bachelor on Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
493224NYMDDiabetes Educator Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341619200000",
    "number": "1699030593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "376 BROADWAY",
            "address_2": "# 14A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100133940",
            "telephone_number": "212-227-9619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "376 BROADWAY",
            "address_2": "APT 14A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100133940",
            "telephone_number": "212-227-9619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "SHIRLEY",
        "middle_name": "YU",
        "name_prefix": "Ms.",
        "credential": "RN, BSN, CDE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-07",
        "last_updated": "2012-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "NY",
            "license": "493224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.