Healthcare Provider Details

I. General information

NPI: 1902597883
Provider Name (Legal Business Name): SHAYANA SUPREME LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N MAIN ST UNIT 1241
NEW CITY NY
10956-7585
US

IV. Provider business mailing address

245 N MAIN ST UNIT 1241
NEW CITY NY
10956-7585
US

V. Phone/Fax

Practice location:
  • Phone: 845-893-5384
  • Fax: 845-542-8534
Mailing address:
  • Phone: 845-893-5384
  • Fax: 845-542-8534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number576214185
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: