Healthcare Provider Details

I. General information

NPI: 1497613467
Provider Name (Legal Business Name): SHAILYN RIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 THIERIOT AVE
BRONX NY
10460-3811
US

IV. Provider business mailing address

1425 THIERIOT AVE APT 5H
BRONX NY
10460-3815
US

V. Phone/Fax

Practice location:
  • Phone: 917-608-9754
  • Fax:
Mailing address:
  • Phone: 917-608-9754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1851863241
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: