Provider Demographics
NPI:1881309987
Name:WEISS, SHIRA RACHEL (PSYD)
Entity type:Individual
Prefix:
First Name:SHIRA
Middle Name:RACHEL
Last Name:WEISS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3410
Mailing Address - Country:US
Mailing Address - Phone:516-376-8465
Mailing Address - Fax:
Practice Address - Street 1:688 WILDWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3410
Practice Address - Country:US
Practice Address - Phone:516-376-8465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020085103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical