Individual
SHENISSA M HYDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2765 MATTHEWS AVE APT 5A, BRONX, NY 10467-8620
(121) 236-5847
Mailing address
2765 MATTHEWS AVE APT 5A, BRONX, NY 10467-8620
(121) 236-5847
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
NY
Other
Enumeration date
10/09/2020
Last updated
10/09/2020
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