Provider Demographics
NPI:1568879518
Name:THEALL, DAWN ELIZABETH (MS SPED/MS SBL)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:ELIZABETH
Last Name:THEALL
Suffix:
Gender:F
Credentials:MS SPED/MS SBL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CHESTNUT RIDGE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5600
Mailing Address - Country:US
Mailing Address - Phone:845-738-4362
Mailing Address - Fax:845-738-1011
Practice Address - Street 1:11 GREENRIDGE AVE
Practice Address - Street 2:1B
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1245
Practice Address - Country:US
Practice Address - Phone:914-837-7267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1396607174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist