Healthcare Provider Details

I. General information

NPI: 1659235067
Provider Name (Legal Business Name): ELIANA SHAKT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 CHURCH RD
WYNCOTE PA
19095-1800
US

IV. Provider business mailing address

3600 JACOB STOUT RD UNIT 11
DOYLESTOWN PA
18902-9096
US

V. Phone/Fax

Practice location:
  • Phone: 215-884-9990
  • Fax:
Mailing address:
  • Phone: 267-418-9474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC021145
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: