=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598341752
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHIRLEY AIME ABBELARD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2021
-----------------------------------------------------
Last Update Date | 03/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 470 NEW DORP LN
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10306-4914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-956-5214
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 595 JEFFERSON AVE APT 1
-----------------------------------------------------
City | ELIZABETH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07201-1138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-956-5214
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 025465
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------