Provider Demographics
NPI:1881356046
Name:WATSON-SHEBAR, SHAMAINE (MSC)
Entity type:Individual
Prefix:MRS
First Name:SHAMAINE
Middle Name:
Last Name:WATSON-SHEBAR
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 GREGORY AVE APT C402
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-5746
Mailing Address - Country:US
Mailing Address - Phone:312-479-6214
Mailing Address - Fax:
Practice Address - Street 1:107 W 82ND ST STE P101
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5511
Practice Address - Country:US
Practice Address - Phone:646-389-4112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician