MEDICARE: SYAISHA HEWITT M.S ED

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	251B00000X	Case Management Agency
2	390200000X	Student in an Organized Health Care Education/Training Program
3	171M00000X	Case Manager/Care Coordinator
4	103TS0200X	School Psychologist	2930792	NY

General Provider Information

NPI Number	:	1871000521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYAISHA HEWITT M.S ED

Provider Business Mailing Address
First Line	:	684 GEORGIA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-6710
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	684 GEORGIA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-6710
Country	:	US
Telephone Number	:	718-431-5549
Fax Number	:

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

Provider Enumeration Date	:	01/03/2018
Last Update Date	:	10/25/2018

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