Provider Demographics
NPI:1053675850
Name:HEFTER, SHIRA J (MSED)
Entity Type:Individual
Prefix:MRS
First Name:SHIRA
Middle Name:J
Last Name:HEFTER
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:SHIRA
Other - Middle Name:J
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:387 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1433
Mailing Address - Country:US
Mailing Address - Phone:516-371-5403
Mailing Address - Fax:
Practice Address - Street 1:387 W BROADWAY
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1433
Practice Address - Country:US
Practice Address - Phone:516-371-5403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist