Provider Demographics
NPI:1760547046
Name:ILANI, SHELLA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHELLA
Middle Name:
Last Name:ILANI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E 66TH ST
Mailing Address - Street 2:# 4 C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-9308
Mailing Address - Country:US
Mailing Address - Phone:646-873-0088
Mailing Address - Fax:
Practice Address - Street 1:145 E 27TH ST
Practice Address - Street 2:SUITE 1-G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9017
Practice Address - Country:US
Practice Address - Phone:646-873-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015913103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist