Provider Demographics
NPI:1467943183
Name:PULVIDENTE, KATHERINE SHEA
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SHEA
Last Name:PULVIDENTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FRANKLIN BLVD APT 3N
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4502
Mailing Address - Country:US
Mailing Address - Phone:631-942-2224
Mailing Address - Fax:
Practice Address - Street 1:25 FRANKLIN BLVD APT 3N
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4502
Practice Address - Country:US
Practice Address - Phone:631-942-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency