Provider Demographics
NPI:1972152981
Name:CHALLENOR, SHANI
Entity Type:Individual
Prefix:
First Name:SHANI
Middle Name:
Last Name:CHALLENOR
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 1:1400 OLD COUNTRY RD FAMILY OF KIDZ
Mailing Address - Street 2:SUITE C103N
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590
Mailing Address - Country:US
Mailing Address - Phone:516-806-6969
Mailing Address - Fax:
Practice Address - Street 1:1400 OLD COUNTRY ROAD
Practice Address - Street 2:SUITE C103N
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590
Practice Address - Country:US
Practice Address - Phone:718-598-5380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2023-08-25
Deactivation Date:2023-02-21
Deactivation Code:
Reactivation Date:2023-08-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist