Healthcare Provider Details

I. General information

NPI: 1548164080
Provider Name (Legal Business Name): MR. SHAQUAN J COMRIE I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 N 7TH AVE APT 1
MOUNT VERNON NY
10550-1792
US

IV. Provider business mailing address

319 N 7TH AVE
MOUNT VERNON NY
10550-1792
US

V. Phone/Fax

Practice location:
  • Phone: 347-765-8698
  • Fax: 347-765-8696
Mailing address:
  • Phone: 347-765-8698
  • Fax: 347-765-8696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number377725035
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: