Look up the most recent NPI and PECOS records

Mijung Shin

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

2015 Grand Concourse, Bronx, NY 10453

PECOS Enrollment

Based on the most recent information from CMS, provider Mijung Shin is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1306377254
Provider Type
Individual
Full Name
Shin, Mijung
Gender
Female

Sole Proprietor
Yes
Enumeration Date
3/22/2017
Last Updated
11/1/2018

Contact Information

Practice Location

2015 Grand Concourse, Bronx, NY 10453

(718) 299-7295

Unlisted Fax

Mailing Location

3198 Grand Concourse, Bronx, NY 10458-1000

(718) 618-0401

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License F341131 New York
Code 364SF0001X	Description Clinical Nurse Specialist Physician Assistants & Advanced Practice Nursing Providers	License F341131 New York

Mijung Shin

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Carr-Celestine, Schevaughn

Akilu, Sahadatu

Jennings, Sarah C

Taylor, Sharleen

Martey, Juliet

Jeon, Su Yeon

Nwaoha, Nkechi

Mathieu, Farah Eloise

Kipiani, Khatuna

Adom, Yaw