Healthcare Provider Details

I. General information

NPI: 1609343409
Provider Name (Legal Business Name): SHANNEL NIALL PINKARD LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 GREYSTONE LN APT 5
ROCHESTER NY
14618-4968
US

IV. Provider business mailing address

184 GREYSTONE LN APT 5
ROCHESTER NY
14618-4968
US

V. Phone/Fax

Practice location:
  • Phone: 585-236-0940
  • Fax:
Mailing address:
  • Phone: 585-236-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number002775
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: