MEDICARE: SHAYE WHALEY

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	40QA02397600	NJ

General Provider Information

NPI Number	:	1770434201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYE WHALEY

Provider Business Mailing Address
First Line	:	109 4TH ST
Second Line	:
City	:	WOOD RIDGE
State	:	NJ
Zip	:	07075-2236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 UNION AVE STE 110
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-1272
Country	:	US
Telephone Number	:	201-642-2776
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ SHAYE WHALEY ” Practice Location

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