Individual
SHANEQUA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
628 TINTON AVE, 3RD FLOOR P17X @161, BRONX, NY 10455
(718) 993-5642
Mailing address
30 EHRBAR AVE APT 409, MOUNT VERNON, NY 10552-3674
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
Other
Enumeration date
12/22/2016
Last updated
12/22/2016
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