MEDICARE: SHALL WE DANCE LLC

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	225600000X	Dance Therapist

General Provider Information

NPI Number	:	1871435537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHALL WE DANCE LLC

Provider Business Mailing Address
First Line	:	635 BAY AVE
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-3349
Country	:	US
Telephone Number	:	732-473-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	635 BAY AVE
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-3349
Country	:	US
Telephone Number	:	732-473-9600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NELSON IBACACHE
Credential	:
Telephone Number	:	732-473-9600

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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Directions to “SHALL WE DANCE LLC ” Practice Location

Language	Start Address	Practice Location

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