Provider Demographics
NPI:1528212339
Name:DINABURG-AZOFF, SHEILA FAE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:FAE
Last Name:DINABURG-AZOFF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 VANDEBOGART RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1925
Mailing Address - Country:US
Mailing Address - Phone:845-679-5343
Mailing Address - Fax:
Practice Address - Street 1:268 W SAUGERTIES RD
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-3142
Practice Address - Country:US
Practice Address - Phone:845-247-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008159103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool