Provider Demographics
NPI:1245594886
Name:BETTY-DENTON, SHANTAY (SPECIAL EDUCATOR)
Entity Type:Individual
Prefix:
First Name:SHANTAY
Middle Name:
Last Name:BETTY-DENTON
Suffix:
Gender:F
Credentials:SPECIAL EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 E LAKELAND ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-1928
Mailing Address - Country:US
Mailing Address - Phone:917-561-0178
Mailing Address - Fax:
Practice Address - Street 1:27 E LAKELAND ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-1928
Practice Address - Country:US
Practice Address - Phone:917-561-0178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency