Provider Demographics
NPI:1144753716
Name:SHON, SUJUNG (RN)
Entity Type:Individual
Prefix:
First Name:SUJUNG
Middle Name:
Last Name:SHON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ROUTE 303
Mailing Address - Street 2:SUITE D
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-5906
Mailing Address - Country:US
Mailing Address - Phone:845-268-1795
Mailing Address - Fax:845-268-3964
Practice Address - Street 1:140 ROUTE 303
Practice Address - Street 2:SUITE D
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-5906
Practice Address - Country:US
Practice Address - Phone:845-268-1795
Practice Address - Fax:845-268-3964
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY560848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health