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General NPI Number Information
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NPI Number | 1295753416
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Entity Type | Individual
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Provider Name | SHATIECE RILEY PHD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 02/18/2014
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Provider Practice Location Address
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Address Line | 280 MADISON AVE SUITE 205
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City | NEW YORK
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State | NY
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Zip | 10016-0801
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Country | US
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Telephone | 646-359-6685
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Fax | 646-359-6685
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Provider Business Mailing Address
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Address Line | 1675 YORK AVE APT 30H
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City | NEW YORK
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State | NY
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Zip | 10128-6752
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Country | US
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Telephone | 646-359-6685
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Fax | 646-359-6685
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 016729
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License Number State | NY
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