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General NPI Number Information
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NPI Number | 1780084673
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Entity Type | Organization
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Legal Business Name | EARLY INTERVENTION SPECIALIST
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Dates
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Enumeration Date | 08/27/2014
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 543 MAIN ST APT 414
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-7265
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Country | US
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Telephone | 917-583-4937
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Fax |
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Provider Business Mailing Address
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Address Line | 543 MAIN ST APT 414
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-7265
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Country | US
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Telephone | 917-583-4937
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Fax |
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Authorized Official
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Title or Position | SPECIAL EDUCATION TEACHER
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Name | SHAUNDELL MARCIA DAVIS-THOMAS
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Credential | MSED
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Telephone | 917-583-4937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 689745
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License Number State | NY
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