Provider Demographics
NPI:1255737821
Name:EVANS, SHENELL (PHD)
Entity type:Individual
Prefix:DR
First Name:SHENELL
Middle Name:
Last Name:EVANS
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 COURT ST STE 409
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11242-1134
Mailing Address - Country:US
Mailing Address - Phone:845-287-5705
Mailing Address - Fax:646-652-6134
Practice Address - Street 1:26 COURT ST STE 409
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1134
Practice Address - Country:US
Practice Address - Phone:929-396-1184
Practice Address - Fax:646-652-6134
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-2197-0103TC0700X
NY020783103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical