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SHADY BOURHAM
NPI 1316480643
Licensed Practical Nurse in Brooklyn, NY

Active since November 18, 2016
6321 NEW UTRECHT AVE, BROOKLYN, NY 11219(212) 687-7464(212) 257-7016 Get Directions Write a Review

NPPES record last updated: November 18, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shady Bourham NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHADY BOURHAM (NPI 1316480643) is an individual licensed practical nurse in Brooklyn, New York, licensed in New York (327253) and active in the NPI registry since November 2016.

NPPES Registry Identity

NPI1316480643
Entity TypeIndividualMale
Primary Taxonomy164W00000X
Provider Legal NameSHADY BOURHAM
Location Address6321 NEW UTRECHT AVEBrooklyn, NY 11219-5425
Mailing Address250 Central Ave, Apt215-bNewark, NJ 07103-4201 · (203) 252-8704
Phone(212) 687-7464
Fax(212) 257-7016
Sole ProprietorYes
Enumeration DateNovember 18, 2016
✔ NPI 1316480643 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Practical NurseNursing Service Providers
Taxonomy Code164W00000X
License✔ Licensed in NY · 327253
Definition
A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
6321 NEW UTRECHT AVE, Brooklyn, NY 11219
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

STACIA GIBBS
Licensed Practical Nurse
6321 NEW UTRECHT AVE
BROOKLYN, NY 11219
Kings County (212) 687-7464
YASMINE HALL
Licensed Practical Nurse
6321 NEW UTRECHT AVE
BROOKLYN, NY 11219
Kings County (212) 687-7464
OPEOLUWA ADEBANJO-OLAITAN
Licensed Practical Nurse
6321 NEW UTRECHT AVE
BROOKLYN, NY 11219
Kings County (212) 687-7464
DIANA REYNOSO
Registered Nurse
6321 NEW UTRECHT AVE
BROOKLYN, NY 11219
Kings County (212) 687-7464
JOSE VILLANUEVA
Registered Nurse
6321 NEW UTRECHT AVE
BROOKLYN, NY 11219
Kings County (212) 687-7464
MS. MAUREEN EVAL HILLARY
Licensed Practical Nurse
6321 NEW UTRECHT AVE
BROOKLYN, NY 11219
Kings County (212) 687-7464
CAROLYN DAVIS
Licensed Practical Nurse
6321 NEW UTRECHT AVE
BROOKLYN, NY 11219
Kings County (212) 687-7464
KADI-ANN G CLACHAR
Licensed Practical Nurse
6321 NEW UTRECHT AVE
BROOKLYN, NY 11219
Kings County (212) 687-7464

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shady Bourham's NPI number?

The NPI number for Shady Bourham is 1316480643. It was assigned to this individual provider in the NPPES registry on November 18, 2016.

Where is Shady Bourham located?

Shady Bourham practices at 6321 New Utrecht Ave, Brooklyn, NY 11219. The listed phone number is (212) 687-7464.

What is Shady Bourham's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

When was this NPI record last updated?

The NPPES record for Shady Bourham was last updated on November 18, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.