Healthcare Provider Details

I. General information

NPI: 1205136561
Provider Name (Legal Business Name): SHAKIRA S SHEARD-STEWART MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 E 240TH ST
BRONX NY
10470-1513
US

IV. Provider business mailing address

624 E 240TH ST
BRONX NY
10470-1513
US

V. Phone/Fax

Practice location:
  • Phone: 718-994-4999
  • Fax:
Mailing address:
  • Phone: 718-994-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1194804
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: