Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 005525-1 | NY |
N | 101YP2500X | Professional Counselor | 005525-1 | NY |
NPI | 1003211483 |
---|---|
Provider Name | Mrs. Shameela Inderdeo |
First Address | Valley Stream, NY 11580 |
Second Address | Valley Stream, NY 11580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2014 |
Last Update Date | 28/10/2014 |