Provider Demographics
NPI:1891406781
Name:FAIZY, SHANNON (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:FAIZY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6270 JOHNSTON RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-4309
Mailing Address - Country:US
Mailing Address - Phone:518-456-3771
Mailing Address - Fax:
Practice Address - Street 1:6270 JOHNSTON RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-4309
Practice Address - Country:US
Practice Address - Phone:518-456-3771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1181041041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool