Healthcare Provider Details

I. General information

NPI: 1346757879
Provider Name (Legal Business Name): SHW GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8213 CESSNA DR
SPRING HILL FL
34606-3024
US

IV. Provider business mailing address

101 BROADWAY APT 602
BROOKLYN NY
11249-6034
US

V. Phone/Fax

Practice location:
  • Phone: 866-244-9556
  • Fax: 866-244-9556
Mailing address:
  • Phone: 718-599-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: SHIA ROSENBAUM
Title or Position: CEO
Credential:
Phone: 917-301-5254