Provider Demographics
NPI:1134522758
Name:SHEARS, SALISHA
Entity type:Individual
Prefix:
First Name:SALISHA
Middle Name:
Last Name:SHEARS
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 1:435 E 92ND ST
Mailing Address - Street 2:1F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-1147
Mailing Address - Country:US
Mailing Address - Phone:917-833-5505
Mailing Address - Fax:
Practice Address - Street 1:435 E 92ND ST
Practice Address - Street 2:1F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-1147
Practice Address - Country:US
Practice Address - Phone:917-833-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-28
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
252Y00000XOtherCITY PRO GROUP, INC.