Provider Demographics
NPI:1306375753
Name:LAYNE, SHAVONA SHAMIKA
Entity type:Individual
Prefix:
First Name:SHAVONA
Middle Name:SHAMIKA
Last Name:LAYNE
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 1:25 SECOND AVENUE, UNIT 136,
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717
Mailing Address - Country:US
Mailing Address - Phone:631-918-0807
Mailing Address - Fax:
Practice Address - Street 1:25 SECOND AVENUE, UNIT 136,
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717
Practice Address - Country:US
Practice Address - Phone:631-918-0807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2025-02-13
Deactivation Date:2021-01-25
Deactivation Code:
Reactivation Date:2025-02-12
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker