Individual
SHAREEFA AKISIA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8725 136TH ST, RICHMOND HILL, NY 11418-1924
(718) 291-2807
Mailing address
PO BOX 30246, ELMONT, NY 11003
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
1047796161
NY
Other
Enumeration date
09/12/2017
Last updated
09/12/2017
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