Provider Demographics
NPI:1609224419
Name:SWABY, SHERIDAH Q (MA)
Entity type:Individual
Prefix:MISS
First Name:SHERIDAH
Middle Name:Q
Last Name:SWABY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24604 139TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2223
Mailing Address - Country:US
Mailing Address - Phone:516-673-5178
Mailing Address - Fax:
Practice Address - Street 1:1441 OLD NORTHERN BLVD
Practice Address - Street 2:BEACON THERAPY SERVICES
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2146
Practice Address - Country:US
Practice Address - Phone:516-625-6846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist