Provider Demographics
NPI:1275087355
Name:COLLEEN SHAND
Entity Type:Organization
Organization Name:COLLEEN SHAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEACHING
Authorized Official - Prefix:MISS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:ANNMARIE
Authorized Official - Last Name:SHAND
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS IN EDUCATION
Authorized Official - Phone:347-755-5432
Mailing Address - Street 1:4211 AVENUE K APT 1F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4959
Mailing Address - Country:US
Mailing Address - Phone:347-755-5432
Mailing Address - Fax:
Practice Address - Street 1:4211 AVENUE K APT 1F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4959
Practice Address - Country:US
Practice Address - Phone:347-755-5432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-06
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2203020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty