Active NPI
Shareefa Akisia Wallace
- School Psychologist
- Richmond Hill, NY
National Provider Identifier
1760901615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 1047796161
- Practice address
- 8725 136TH St
Richmond Hill, NY 11418-1924 - Phone
- (718) 291-2807
- NPI assigned
- Sep 12, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 1047796161 | NY | Primary |
Addresses
Primary practice location
8725 136TH St
Richmond Hill, NY 11418-1924
Mailing address
PO Box 30246
Elmont, NY 11003
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1047796161 | NY | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1505174400000",
"number": "1760901615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 30246",
"city": "ELMONT",
"state": "NY",
"postal_code": "11003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8725 136TH ST",
"city": "RICHMOND HILL",
"state": "NY",
"postal_code": "114181924",
"telephone_number": "718-291-2807"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "SHAREEFA",
"middle_name": "AKISIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-12",
"last_updated": "2017-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "NY",
"license": "1047796161",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond Hill, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.