1104024819 NPI number — MISS SHAYNA TERLENE SANDERS LMFT

Table of content: MISS SHAYNA TERLENE SANDERS LMFT (NPI 1104024819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104024819 NPI number — MISS SHAYNA TERLENE SANDERS LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDERS
Provider First Name:
SHAYNA
Provider Middle Name:
TERLENE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104024819
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2335 DIXWELL AVE STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06514-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-518-1964
Provider Business Mailing Address Fax Number:
888-685-3047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2335 DIXWELL AVE STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06514-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-518-1964
Provider Business Practice Location Address Fax Number:
888-685-3047
Provider Enumeration Date:
07/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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