Provider Demographics
NPI:1508597170
Name:DINGLE, SHAMEL F
Entity Type:Individual
Prefix:
First Name:SHAMEL
Middle Name:F
Last Name:DINGLE
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 1:1091-93 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07114
Mailing Address - Country:US
Mailing Address - Phone:862-270-6137
Mailing Address - Fax:
Practice Address - Street 1:680 JOHN F. KENNEDY BOULEVARD
Practice Address - Street 2:APT.205
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-0700
Practice Address - Country:US
Practice Address - Phone:201-884-3672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor