Provider Demographics
NPI:1982368916
Name:SHENK, LYNNETTE A
Entity Type:Individual
Prefix:MS
First Name:LYNNETTE
Middle Name:A
Last Name:SHENK
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 1:30 DANIEL LOW TER APT 5T
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1741
Mailing Address - Country:US
Mailing Address - Phone:347-740-6270
Mailing Address - Fax:
Practice Address - Street 1:30 DANIEL LOW TER APT 5T
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1741
Practice Address - Country:US
Practice Address - Phone:347-740-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist