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General NPI Number Information
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NPI Number | 1154213338
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Entity Type | Individual
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Provider Name | ELYSIA SHEVAT-MCBROOM
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Gender | Female
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 295 MAIN ST RM 766
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City | BUFFALO
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State | NY
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Zip | 14203-2507
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Country | US
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Telephone | 888-975-2256
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Fax | 607-930-4184
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Provider Business Mailing Address
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Address Line | 28 N COUNTRY RD STE 101A
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City | MOUNT SINAI
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State | NY
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Zip | 11766-1518
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Country | US
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Telephone | 888-975-2256
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Fax | 607-930-4148
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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