Provider Demographics
NPI:1790178408
Name:VERNISIE, SHAWNA NICOLE (LCAT)
Entity Type:Individual
Prefix:MISS
First Name:SHAWNA
Middle Name:NICOLE
Last Name:VERNISIE
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-4443
Mailing Address - Country:US
Mailing Address - Phone:631-275-5423
Mailing Address - Fax:
Practice Address - Street 1:269 S 15TH ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4443
Practice Address - Country:US
Practice Address - Phone:631-275-5423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001753225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist