| Doctor Name: | PROF. KENSHASA SHABAKA |
| NPI Number: | 1225343585 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MENTAL HEALTH CONSUL |
| License Number: | 003807 |
| Business Practice Address: | 31 Cosdrew Ln # Ny11937 East Hampton, NY - 119372541 |
| Business Phone Number: | 9177511751 |
| Business Fax Number: | 7183997427 |
| Mailing Address: | 31 Cosdrew Ln # Ny11937, EAST HAMPTON |
| State: | NY |
| Postal Code: | 119372541 |
| Phone Number: | 9177511751 |
| Fax Number: | 7183997427 |
| NPI Enumeration Date: | 08/11/2010 |
| NPI Last Update Date: | 08/11/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 003807 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |