Provider Demographics
NPI:1033392469
Name:EVARISTO, SHIARREE
Entity Type:Individual
Prefix:
First Name:SHIARREE
Middle Name:
Last Name:EVARISTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-35 97 STREET
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421
Mailing Address - Country:US
Mailing Address - Phone:347-965-3356
Mailing Address - Fax:
Practice Address - Street 1:91-35 97TH STREET
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421
Practice Address - Country:US
Practice Address - Phone:347-965-3356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist