Individual
SHANTELL REID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6080 JERICHO TPKE, COMMACK, NY 11725-2850
(631) 864-7770
Mailing address
6080 JERICHO TPKE, COMMACK, NY 11725-2850
(631) 864-7770
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/07/2023
Last updated
02/07/2023
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