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General NPI Number Information
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NPI Number | 1396974028
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Entity Type | Individual
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Provider Name | SHELLY S. MISIR OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 15048 87TH RD
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City | JAMAICA
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State | NY
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Zip | 11432-3312
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Country | US
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Telephone | 917-776-0177
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Fax | 718-298-6801
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Provider Business Mailing Address
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Address Line | 15048 87TH RD
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City | JAMAICA
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State | NY
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Zip | 11432-3312
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Country | US
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Telephone | 917-776-0177
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Fax | 718-298-6801
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 009676
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License Number State | NY
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