Provider Demographics
NPI:1205136561
Name:SHEARD-STEWART, SHAKIRA S (MS)
Entity type:Individual
Prefix:
First Name:SHAKIRA
Middle Name:S
Last Name:SHEARD-STEWART
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 E 240TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1513
Mailing Address - Country:US
Mailing Address - Phone:718-994-4999
Mailing Address - Fax:
Practice Address - Street 1:624 E 240TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1513
Practice Address - Country:US
Practice Address - Phone:718-994-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1194804103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool