Healthcare Provider Details

I. General information

NPI: 1649185448
Provider Name (Legal Business Name): SNEHA SIVAKUMAR PTA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 E 149TH ST
BRONX NY
10451-5602
US

IV. Provider business mailing address

10 TROY ST
EDISON NJ
08820-2421
US

V. Phone/Fax

Practice location:
  • Phone: 718-928-6582
  • Fax:
Mailing address:
  • Phone: 848-247-8823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number015422
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: