Provider Demographics
NPI:1407995566
Name:SHAFFERY, MONICA ANN (MS IN EDUCATION)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:ANN
Last Name:SHAFFERY
Suffix:
Gender:F
Credentials:MS IN EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 KALMIA ST
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1213
Mailing Address - Country:US
Mailing Address - Phone:631-912-9133
Mailing Address - Fax:
Practice Address - Street 1:4 KALMIA ST
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1213
Practice Address - Country:US
Practice Address - Phone:631-912-9133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)