MEDICARE: JENNIFER SHIRA DAUM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	221700000X	Art Therapist	003248	NY

General Provider Information

NPI Number	:	1326997891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SHIRA DAUM

Provider Business Mailing Address
First Line	:	170 E 87TH ST APT E16H
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-2288
Country	:	US
Telephone Number	:	832-367-7772
Fax Number	:

Provider Business Practice Location Address
First Line	:	96 5TH AVE APT 1L
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-7604
Country	:	US
Telephone Number	:	832-367-7772
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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