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General NPI Number Information
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NPI Number | 1306100235
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Entity Type | Individual
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Provider Name | ELSIE SHEGBONE SPECIAL EDUCATION
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Gender | Female
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 8866 MYRTLE AVE
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City | GLENDALE
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State | NY
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Zip | 11385-7857
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Country | US
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Telephone | 718-850-0400
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Fax | 718-850-4441
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Provider Business Mailing Address
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Address Line | 1 RALSTON WAY
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City | MONROE
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State | NJ
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Zip | 08831-2901
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Country | US
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Telephone | 732-521-4215
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Fax | 732-521-4215
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 759736971
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License Number State | NJ
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