Healthcare Provider Details

I. General information

NPI: 1922380724
Provider Name (Legal Business Name): SHIRA SLIFFMAN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 BUTTERNUT ST NW
WASHINGTON DC
20012-1930
US

IV. Provider business mailing address

612 BUTTERNUT ST NW
WASHINGTON DC
20012-1930
US

V. Phone/Fax

Practice location:
  • Phone: 202-243-8942
  • Fax: 202-722-7212
Mailing address:
  • Phone: 202-243-8942
  • Fax: 202-722-7212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119005250
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: