Provider Demographics
NPI:1689988776
Name:PENSTEIN, SHOSHANA (MA)
Entity Type:Individual
Prefix:MRS
First Name:SHOSHANA
Middle Name:
Last Name:PENSTEIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2815
Mailing Address - Country:US
Mailing Address - Phone:516-284-7281
Mailing Address - Fax:
Practice Address - Street 1:367 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2815
Practice Address - Country:US
Practice Address - Phone:516-284-7281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist