Provider Demographics
NPI:1255426045
Name:REBELLO-EIAN, SHEILA RITA (PHD)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:RITA
Last Name:REBELLO-EIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EVERGREEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953
Mailing Address - Country:US
Mailing Address - Phone:631-504-6363
Mailing Address - Fax:
Practice Address - Street 1:49 OAKCREST AVENUE
Practice Address - Street 2:OAK HOLLOW NURSING CENTER
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953
Practice Address - Country:US
Practice Address - Phone:631-504-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013901103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01983384Medicaid
NY132500OtherVYTRA
NY166561POtherHIP
NYV82341Medicare UPIN
NYV82341Medicare PIN