Provider Demographics
NPI:1487885380
Name:LAL, IANA SHANI
Entity type:Individual
Prefix:MRS
First Name:IANA
Middle Name:SHANI
Last Name:LAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IANA
Other - Middle Name:SHANI
Other - Last Name:CHERUBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1240 DELAWARE AVE
Mailing Address - Street 2:308
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1443
Mailing Address - Country:US
Mailing Address - Phone:917-202-5305
Mailing Address - Fax:
Practice Address - Street 1:2470 WALDEN AVE
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4751
Practice Address - Country:US
Practice Address - Phone:716-681-5718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health