Provider Demographics
NPI:1285771329
Name:TENNYSON, SHIRLEY
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:TENNYSON
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 1:480 PARK AVE
Mailing Address - Street 2:APT 3-J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1613
Mailing Address - Country:US
Mailing Address - Phone:212-644-1688
Mailing Address - Fax:212-319-6049
Practice Address - Street 1:20 PLAZA WEST
Practice Address - Street 2:CEDARWOOD HALL
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1681
Practice Address - Country:US
Practice Address - Phone:914-493-7274
Practice Address - Fax:914-493-8190
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4668235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist