Basic Information
| Provider Information | |||||||||
| NPI: | 1972800589 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHANDAL | ||||||||
| FirstName: | NISHA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95000 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191954655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004446020 | ||||||||
| FaxNumber: | 8452551881 | ||||||||
| Practice Location | |||||||||
| Address1: | 1879 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100352709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124234500 | ||||||||
| FaxNumber: | 2124234577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2011 | ||||||||
| LastUpdateDate: | 02/23/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | P78924 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.