Basic Information
Provider Information
NPI: 1205486214
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHLEIWET
FirstName: AMIRA
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: COTA/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 39 LENNON AVE
Address2:  
City: YONKERS
State: NY
PostalCode: 107015935
CountryCode: US
TelephoneNumber: 9142307205
FaxNumber:  
Practice Location
Address1: 1156 N BROADWAY
Address2:  
City: YONKERS
State: NY
PostalCode: 107011108
CountryCode: US
TelephoneNumber: 9149653700
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/12/2019
LastUpdateDate: 09/12/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
224Z00000X009719NYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant 

No ID Information.


Home