Individual
SHANA NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
63 OLD EAST NECK RD, MELVILLE, NY 11747-2806
(631) 923-0923
Mailing address
63 OLD EAST NECK RD, MELVILLE, NY 11747-2806
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
016634
NY
103TC0700X
Clinical Psychologist
001285
IA
103TC0700X
Clinical Psychologist
2011000658
MO
103TC0700X
Clinical Psychologist
2951
CO
Other
Enumeration date
09/29/2006
Last updated
04/20/2015
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