Individual
AISIA SHACKELFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
905 COUNTY BUILDING, CAIRO, NY 12413
(518) 622-9163
Mailing address
11 GLENWOOD BLVD APT 1, HUDSON, NY 12534-2318
(518) 567-9757
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
105677
NY
Other
Enumeration date
11/13/2019
Last updated
11/13/2019
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