Provider Demographics
NPI:1629275854
Name:SHASHA, LESLIE JOY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JOY
Last Name:SHASHA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:JOY
Other - Last Name:SHASHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:35 GARDEN PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4501
Mailing Address - Country:US
Mailing Address - Phone:718-858-9712
Mailing Address - Fax:
Practice Address - Street 1:35 GARDEN PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4501
Practice Address - Country:US
Practice Address - Phone:718-858-9712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013273103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2791971OtherOXFORD