Healthcare Provider Details

I. General information

NPI: 1366675365
Provider Name (Legal Business Name): SHANEL ALIAH BOYCE LCSW,LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 WATER ST STE 9
BINGHAMTON NY
13901-2771
US

IV. Provider business mailing address

44 RIVERSIDE ST
BINGHAMTON NY
13904-1620
US

V. Phone/Fax

Practice location:
  • Phone: 607-296-0175
  • Fax:
Mailing address:
  • Phone: 607-296-0175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100720
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number296896
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number105199
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: