Individual
FANNIE SHIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7 CENTURY HILL DR, LATHAM, NY 12110-2113
(518) 641-1119
Mailing address
7 CENTURY HILL DR, LATHAM, NY 12110-2113
(518) 641-1119
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
002452
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07638604
—
NY
Enumeration date
11/26/2018
Last updated
11/29/2023
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