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General NPI Number Information
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NPI Number | 1306375753
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Entity Type | Individual
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Provider Name | SHAVONA SHAMIKA LAYNE
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Gender | Female
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 25 SECOND AVENUE, UNIT 136,
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City | BRENTWOOD
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State | NY
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Zip | 11717
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Country | US
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Telephone | 631-918-0807
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Fax |
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Provider Business Mailing Address
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Address Line | 25 2ND AVE UNIT 136
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City | BRENTWOOD
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State | NY
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Zip | 11717-8042
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Country | US
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Telephone | 631-918-0807
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 126246
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License Number State | NY
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