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General NPI Number Information
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NPI Number | 1366176034
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Entity Type | Individual
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Provider Name | SHANNON E CONDELLO
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Gender | Female
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Dates
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Enumeration Date | 07/10/2022
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Last Update Date | 04/12/2025
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Provider Practice Location Address
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Address Line | 384 CRYSTAL RUN RD STE 102
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City | MIDDLETOWN
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State | NY
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Zip | 10941-4073
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Country | US
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Telephone | 315-724-4286
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Fax |
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Provider Business Mailing Address
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Address Line | 40 JENNIFER ROSE WAY
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City | WALLKILL
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State | NY
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Zip | 12589-2819
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Country | US
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Telephone | 845-527-2403
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 2995523
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License Number State | NY
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