Provider Demographics
NPI:1659120905
Name:LAWALL, SHARYN
Entity type:Individual
Prefix:
First Name:SHARYN
Middle Name:
Last Name:LAWALL
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 1:200 PANTIGO PLACE SUITE E
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-5921
Mailing Address - Country:US
Mailing Address - Phone:631-324-8030
Mailing Address - Fax:631-324-8032
Practice Address - Street 1:200 PANTIGO PLACE SUITE E
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-5921
Practice Address - Country:US
Practice Address - Phone:631-324-8030
Practice Address - Fax:631-324-8032
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013836-01103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist