Healthcare Provider Details

I. General information

NPI: 1013844406
Provider Name (Legal Business Name): SLL NURSE PRACTITIONER IN PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 5TH AVE SUITE 704
NEW YORK NY
10001-4527
US

IV. Provider business mailing address

276 5TH AVE SUITE 704
NEW YORK NY
10001-4527
US

V. Phone/Fax

Practice location:
  • Phone: 646-381-2952
  • Fax: 646-658-4357
Mailing address:
  • Phone: 646-381-2952
  • Fax: 646-658-4357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHANEIKA LINDSAY
Title or Position: NURSE PRACTITIONER
Credential: PMHNP
Phone: 646-381-2952