Individual
SHAUN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14 IVANHOE PL, VALLEY STREAM, NY 11580-2902
(917) 975-3906
Mailing address
14 IVANHOE PL, VALLEY STREAM, NY 11580-2902
(917) 975-3906
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/30/2008
Last updated
04/30/2008
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