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General NPI Number Information
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NPI Number | 1861264079
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Entity Type | Individual
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Provider Name | SHIRLEY LEE
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Gender | Female
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 4 W SOUTH ORANGE AVE STE 305
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-4704
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Country | US
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Telephone | 973-327-3371
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Fax |
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Provider Business Mailing Address
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Address Line | 45 MEADOWLANDS PKWY UNIT 322
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City | SECAUCUS
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State | NJ
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Zip | 07094-2971
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Country | US
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Telephone | 646-418-6747
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 031250-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 18KT01184000
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License Number State | NJ
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