Provider Demographics
NPI:1265854400
Name:SHANNON HARVEY, PSY.D
Entity type:Organization
Organization Name:SHANNON HARVEY, PSY.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:631-495-9592
Mailing Address - Street 1:35 TAMARA CT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4147
Mailing Address - Country:US
Mailing Address - Phone:631-495-9592
Mailing Address - Fax:
Practice Address - Street 1:35 TAMARA CT
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4147
Practice Address - Country:US
Practice Address - Phone:631-495-9592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020409305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service