Healthcare Provider Details

I. General information

NPI: 1265351696
Provider Name (Legal Business Name): SHENELLA HONEYGHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2091 HILLSIDE AVE
NEW HYDE PARK NY
11040-2612
US

IV. Provider business mailing address

3 RUDOLPH DR APT 2L
CARLE PLACE NY
11514-1098
US

V. Phone/Fax

Practice location:
  • Phone: 516-862-3360
  • Fax:
Mailing address:
  • Phone: 516-862-3360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number011960-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: