Provider Demographics
NPI:1366978413
Name:ADAMS-DENNIS, SHU-LENE
Entity type:Individual
Prefix:
First Name:SHU-LENE
Middle Name:
Last Name:ADAMS-DENNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHU-LENE
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:127 EDGECOMBE AVE
Mailing Address - Street 2:APT. 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-1402
Mailing Address - Country:US
Mailing Address - Phone:917-539-1871
Mailing Address - Fax:
Practice Address - Street 1:127 EDGECOMBE AVE
Practice Address - Street 2:APT. 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-1402
Practice Address - Country:US
Practice Address - Phone:917-539-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY930489649OtherGHI