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General NPI Number Information
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NPI Number | 1922389824
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Entity Type | Individual
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Provider Name | SHANNON CHANOFSKY PSYD
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Gender | Female
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Dates
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Enumeration Date | 09/06/2011
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 120 DEFREEST DR
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City | TROY
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State | NY
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Zip | 12180-7608
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Country | US
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Telephone | 518-723-0081
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Fax |
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Provider Business Mailing Address
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Address Line | 19 PARKVIEW CT
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City | TROY
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State | NY
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Zip | 12180-5830
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Country | US
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Telephone | 917-847-8744
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 021038
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 021038-01
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License Number State | NY
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