Provider Demographics
NPI:1780231076
Name:SHORE, PERI MICHELE
Entity Type:Individual
Prefix:
First Name:PERI
Middle Name:MICHELE
Last Name:SHORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 E LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5420
Mailing Address - Country:US
Mailing Address - Phone:516-967-9554
Mailing Address - Fax:
Practice Address - Street 1:87 E LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5420
Practice Address - Country:US
Practice Address - Phone:516-967-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency