Healthcare Provider Details

I. General information

NPI: 1770904120
Provider Name (Legal Business Name): SHINAKEE GUMBER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E 38TH ST
NEW YORK NY
10016-2708
US

IV. Provider business mailing address

2541 30TH RD APT 4A
ASTORIA NY
11102-2638
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-0309
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number020089
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: