Provider Demographics
NPI:1154213338
Name:SHEVAT-MCBROOM, ELYSIA
Entity type:Individual
Prefix:
First Name:ELYSIA
Middle Name:
Last Name:SHEVAT-MCBROOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 N COUNTRY RD STE 101A
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-1518
Mailing Address - Country:US
Mailing Address - Phone:888-975-2256
Mailing Address - Fax:607-930-4148
Practice Address - Street 1:295 MAIN ST RM 766
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-2507
Practice Address - Country:US
Practice Address - Phone:888-975-2256
Practice Address - Fax:607-930-4184
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health