Healthcare Provider Details

I. General information

NPI: 1437832326
Provider Name (Legal Business Name): SHIM-IN SARAH REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3449 E REZANOF DR
KODIAK AK
99615-6952
US

IV. Provider business mailing address

3449 E REZANOF DR
KODIAK AK
99615-6952
US

V. Phone/Fax

Practice location:
  • Phone: 907-486-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: