Healthcare Provider Details

I. General information

NPI: 1205966363
Provider Name (Legal Business Name): ROOPALATHA P SHENOY OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1979 MARCUS AVENUE SUITE 204 GLOBAL COMMUNICATION SERVICES
LAKE SUCCESS NY
11042
US

IV. Provider business mailing address

4 BEECHWOOD DR
GOSHEN NY
10924-2504
US

V. Phone/Fax

Practice location:
  • Phone: 516-327-4681
  • Fax: 516-327-4684
Mailing address:
  • Phone: 845-469-9175
  • Fax: 845-469-9175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0083411
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: