MEDICARE: MS. SHONDELLE CHARLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	40085	NY

General Provider Information

NPI Number	:	1548127871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHONDELLE CHARLES

Provider Business Mailing Address
First Line	:	746 MACDONOUGH ST APT 2R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-5430
Country	:	US
Telephone Number	:	212-343-3549
Fax Number	:	212-343-3549

Provider Business Practice Location Address
First Line	:	746 MACDONOUGH ST APT 2R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-5430
Country	:	US
Telephone Number	:	212-343-3549
Fax Number	:	212-343-3549

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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