MEDICARE: SHAELYN ANNUNZIATA PT

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	225100000X	Physical Therapist	40QA01549600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40QA01549600	OTHER	NJ	PT LICENSE

General Provider Information

NPI Number	:	1508205865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAELYN ANNUNZIATA PT

Provider Business Mailing Address
First Line	:	198 OLD BERGEN RD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-2622
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	198 OLD BERGEN RD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-2622
Country	:	US
Telephone Number	:	201-433-0950
Fax Number	:

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

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	04/06/2017

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Directions to “ SHAELYN ANNUNZIATA PT” Practice Location

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