Healthcare Provider Details

I. General information

NPI: 1598484594
Provider Name (Legal Business Name): SHAYNE SNYDER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 BROADWAY STE 1505
NEW YORK NY
10036-5521
US

IV. Provider business mailing address

1501 BROADWAY STE 1505
NEW YORK NY
10036-5521
US

V. Phone/Fax

Practice location:
  • Phone: 332-245-0300
  • Fax:
Mailing address:
  • Phone: 332-245-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number015963
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: