Healthcare Provider Details

I. General information

NPI: 1013225101
Provider Name (Legal Business Name): SHIRA GREENBLATT M.S.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HUNGRY HARBOR RD
VALLEY STREAM NY
11581-2511
US

IV. Provider business mailing address

15 SHERIDAN CT
PLAINVIEW NY
11803-5216
US

V. Phone/Fax

Practice location:
  • Phone: 516-791-5315
  • Fax:
Mailing address:
  • Phone: 516-433-3771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number845316
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: