Healthcare Provider Details

I. General information

NPI: 1457284770
Provider Name (Legal Business Name): JACQUELINE SHALAMOV OCCUPATIONAL THERAPY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 67TH RD APT 2D
FOREST HILLS NY
11375-2641
US

IV. Provider business mailing address

10240 67TH RD APT 2D
FOREST HILLS NY
11375-2641
US

V. Phone/Fax

Practice location:
  • Phone: 347-819-0803
  • Fax:
Mailing address:
  • Phone: 347-819-0803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACQUELINE SHALAMOV
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTD, OTD/L
Phone: 347-819-0803