Provider Demographics
NPI:1902419799
Name:REID, SHANNA LYN
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:LYN
Last Name:REID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:LYN
Other - Last Name:SPIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 WHITEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-4050
Mailing Address - Country:US
Mailing Address - Phone:516-680-3364
Mailing Address - Fax:
Practice Address - Street 1:10 OAKLAND AVE STE 2-4
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1515
Practice Address - Country:US
Practice Address - Phone:917-239-6232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health