Provider Demographics
NPI:1326811035
Name:HARRIS, SHANON KINTE
Entity Type:Individual
Prefix:
First Name:SHANON
Middle Name:KINTE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3439 BRUCKNER BLVD OFC
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5249
Mailing Address - Country:US
Mailing Address - Phone:347-657-9011
Mailing Address - Fax:
Practice Address - Street 1:3439 BRUCKNER BLVD OFC
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5249
Practice Address - Country:US
Practice Address - Phone:347-657-9011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001108106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist