Healthcare Provider Details

I. General information

NPI: 1336942556
Provider Name (Legal Business Name): SHANYQ SALOP NP IN PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 41ST AVE
LONG ISLAND CITY NY
11101-2814
US

IV. Provider business mailing address

3010 41ST AVE
LONG ISLAND CITY NY
11101-2814
US

V. Phone/Fax

Practice location:
  • Phone: 646-481-9514
  • Fax: 718-210-9735
Mailing address:
  • Phone: 646-481-9514
  • Fax: 718-210-9735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHANYQ SALOP
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 646-481-9514