MEDICARE: SHULAMIT YUSHANAYEV OTR/L

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	225XP0200X	Pediatric Occupational Therapist	024190	NY

General Provider Information

NPI Number	:	1962049411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHULAMIT YUSHANAYEV OTR/L

Provider Business Mailing Address
First Line	:	6751 179TH ST
Second Line	:
City	:	FRESH MEADOWS
State	:	NY
Zip	:	11365-3539
Country	:	US
Telephone Number	:	347-585-0511
Fax Number	:

Provider Business Practice Location Address
First Line	:	192 E 151ST ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-5292
Country	:	US
Telephone Number	:	347-585-0511
Fax Number	:

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

Provider Enumeration Date	:	12/03/2019
Last Update Date	:	12/03/2019

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