Provider Demographics
NPI:1679818447
Name:PELAEZ-SHEA, GLORIA INES (MS, ED)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:INES
Last Name:PELAEZ-SHEA
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 PEARSALL AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1800
Mailing Address - Country:US
Mailing Address - Phone:516-371-1818
Mailing Address - Fax:516-371-0675
Practice Address - Street 1:385 PEARSALL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1800
Practice Address - Country:US
Practice Address - Phone:516-371-1818
Practice Address - Fax:516-371-0675
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY769089174400000X
NY327147031174400000X
NY327146031174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist