Provider Demographics
NPI:1124597760
Name:JOYANDEH, SHAINA R (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHAINA
Middle Name:R
Last Name:JOYANDEH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-2607
Mailing Address - Country:US
Mailing Address - Phone:908-764-4652
Mailing Address - Fax:
Practice Address - Street 1:2 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-2607
Practice Address - Country:US
Practice Address - Phone:908-764-4652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00828600225X00000X
NY022411-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist