Provider Demographics
NPI:1811709298
Name:GOGGANS, SHANIDA
Entity type:Individual
Prefix:
First Name:SHANIDA
Middle Name:
Last Name:GOGGANS
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 1:540 MORRIS AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-0001
Mailing Address - Country:US
Mailing Address - Phone:347-262-5506
Mailing Address - Fax:
Practice Address - Street 1:1136 NEILL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1328
Practice Address - Country:US
Practice Address - Phone:718-518-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health