Healthcare Provider Details

I. General information

NPI: 1063316917
Provider Name (Legal Business Name): SHELLY SARASTY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W HAWTHORNE AVE
VALLEY STREAM NY
11580-6223
US

IV. Provider business mailing address

50 W HAWTHORNE AVE
VALLEY STREAM NY
11580-6223
US

V. Phone/Fax

Practice location:
  • Phone: 516-596-6600
  • Fax:
Mailing address:
  • Phone: 516-569-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number133774
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: