Provider Demographics
NPI:1740460096
Name:SHACHNER, SUSAN EVE (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:EVE
Last Name:SHACHNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:EVE
Other - Last Name:SHACHNER-SCHULTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:111 JOHN ST
Mailing Address - Street 2:RM 2400
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-3013
Mailing Address - Country:US
Mailing Address - Phone:212-420-1281
Mailing Address - Fax:
Practice Address - Street 1:111 JOHN ST
Practice Address - Street 2:RM 2400
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3013
Practice Address - Country:US
Practice Address - Phone:212-420-1281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-04
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012757103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV31571Medicare PIN