Healthcare Provider Details

I. General information

NPI: 1376260562
Provider Name (Legal Business Name): SHARAYAH L HOFFMANN CASAC 2 37022
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 WASHINGTON ST
MOUNT VERNON NY
10553-1052
US

IV. Provider business mailing address

19 LONGMEADOW RD
YONKERS NY
10704-3813
US

V. Phone/Fax

Practice location:
  • Phone: 914-613-0700
  • Fax:
Mailing address:
  • Phone: 971-409-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37022
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: