Provider Demographics
NPI:1043072101
Name:LLOYD, SHANA
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:LLOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 ADEE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8513
Mailing Address - Country:US
Mailing Address - Phone:646-250-8287
Mailing Address - Fax:718-863-0034
Practice Address - Street 1:779 ADEE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8513
Practice Address - Country:US
Practice Address - Phone:646-250-8287
Practice Address - Fax:718-863-0034
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1761830231252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency