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General NPI Number Information
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NPI Number | 1275087355
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Entity Type | Organization
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Legal Business Name | COLLEEN SHAND
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Dates
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Enumeration Date | 08/06/2016
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Last Update Date | 08/06/2016
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Provider Practice Location Address
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Address Line | 4211 AVENUE K APT 1F
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City | BROOKLYN
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State | NY
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Zip | 11210-4959
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Country | US
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Telephone | 347-755-5432
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Fax |
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Provider Business Mailing Address
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Address Line | 4211 AVENUE K APT 1F
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City | BROOKLYN
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State | NY
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Zip | 11210-4959
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Country | US
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Telephone | 347-755-5432
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Fax |
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Authorized Official
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Title or Position | TEACHING
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Name | MISS COLLEEN ANNMARIE SHAND
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Credential | MASTERS IN EDUCATION
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Telephone | 347-755-5432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2203020
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License Number State | NY
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