Individual
SHAYLA ALYSON VANGURP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
630 MORICHES MIDDLE ISLAND RD, MORICHES, NY 11955-1506
(631) 874-5505
Mailing address
100 RAYNOR RD, RIDGE, NY 11961-1900
(631) 258-2384
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000033529
NY
Other
Enumeration date
08/07/2018
Last updated
08/07/2018
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