Provider Demographics
NPI:1588333777
Name:SOMMER, SHAYNA ANGELINA (CASAC)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:ANGELINA
Last Name:SOMMER
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-7614
Mailing Address - Country:US
Mailing Address - Phone:914-939-2700
Mailing Address - Fax:914-939-5352
Practice Address - Street 1:132 PEARL ST
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-7614
Practice Address - Country:US
Practice Address - Phone:914-393-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)