Provider Demographics
NPI:1932276045
Name:SPASARO, SHEILA A (PHD)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:A
Last Name:SPASARO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 INDUSTRY ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2618
Mailing Address - Country:US
Mailing Address - Phone:845-471-8876
Mailing Address - Fax:845-473-2567
Practice Address - Street 1:8 INDUSTRY ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2618
Practice Address - Country:US
Practice Address - Phone:845-471-8876
Practice Address - Fax:845-473-2567
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013274103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01896648Medicaid
NYS54397Medicare UPIN
NY01896648Medicaid