Provider Demographics
NPI:1710533674
Name:ROBINSON, SHAUN CHARLES (DO)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:CHARLES
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GLEN ST # 234
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-4304
Mailing Address - Country:US
Mailing Address - Phone:800-851-0073
Mailing Address - Fax:
Practice Address - Street 1:50 GLEN ST # 234
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-4304
Practice Address - Country:US
Practice Address - Phone:800-851-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty