Healthcare Provider Details

I. General information

NPI: 1982524609
Provider Name (Legal Business Name): SHAYA WALTER LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 STATE ROUTE 17M
MONROE NY
10950-1606
US

IV. Provider business mailing address

2 MELITZ ST UNIT 204
MONROE NY
10950-2573
US

V. Phone/Fax

Practice location:
  • Phone: 347-397-7998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number018238
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: