Healthcare Provider Details

I. General information

NPI: 1669863932
Provider Name (Legal Business Name): SHEENA ESCARFULLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BROADWAY STE 2710
NEW YORK NY
10007-3032
US

IV. Provider business mailing address

11-42 44TH DRIVE # 12
LONG ISLAND CITY NY
11101
US

V. Phone/Fax

Practice location:
  • Phone: 646-600-8456
  • Fax:
Mailing address:
  • Phone: 646-407-9219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number103K00000X
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberP120468
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: