Provider Demographics
NPI:1972351179
Name:MARTIN, SHEILA J
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:J
Last Name:MARTIN
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 1:545 SAW MILL RIVER RD STE 3A
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-2159
Mailing Address - Country:US
Mailing Address - Phone:347-625-8609
Mailing Address - Fax:
Practice Address - Street 1:545 SAW MILL RIVER RD STE 3A
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2159
Practice Address - Country:US
Practice Address - Phone:347-625-8609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-11
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010255101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health