Healthcare Provider Details

I. General information

NPI: 1588333777
Provider Name (Legal Business Name): SHAYNA ANGELINA SOMMER CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 PEARL ST
PORT CHESTER NY
10573-7614
US

IV. Provider business mailing address

132 PEARL ST
PORT CHESTER NY
10573-7614
US

V. Phone/Fax

Practice location:
  • Phone: 914-393-2700
  • Fax:
Mailing address:
  • Phone: 914-939-2700
  • Fax: 914-939-5352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number34814
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number129783
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: