Healthcare Provider Details

I. General information

NPI: 1760059406
Provider Name (Legal Business Name): PRIYANKA SHOKEEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 BROADWAY FL HALL8
NEW YORK NY
10027-7164
US

IV. Provider business mailing address

2920 BROADWAY FL HALL8
NEW YORK NY
10027-7164
US

V. Phone/Fax

Practice location:
  • Phone: 212-854-2878
  • Fax:
Mailing address:
  • Phone: 212-854-2878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP107397
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: