Provider Demographics
NPI:1043936131
Name:FRIEDMAN, SHAYNA ALEXIS (MOT, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:SHAYNA
Middle Name:ALEXIS
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 CORYELL LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-2114
Mailing Address - Country:US
Mailing Address - Phone:301-461-6295
Mailing Address - Fax:
Practice Address - Street 1:3440 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3145
Practice Address - Country:US
Practice Address - Phone:703-820-1488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119008824225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation