Provider Demographics
NPI:1366003543
Name:TESORIERO-CAPONE, SHELBY (LCAT, ATR-BC)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:TESORIERO-CAPONE
Suffix:
Gender:F
Credentials:LCAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 N BROADWAY FL 3
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-3213
Mailing Address - Country:US
Mailing Address - Phone:203-241-0294
Mailing Address - Fax:
Practice Address - Street 1:19 N BROADWAY FL 3
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-3213
Practice Address - Country:US
Practice Address - Phone:203-241-0294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002272221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty