Provider Demographics
NPI:1225551120
Name:SHADOYAN, ARAM
Entity Type:Individual
Prefix:
First Name:ARAM
Middle Name:
Last Name:SHADOYAN
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 1:1825 BRIDGETOWN PIKE APT 212
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-2371
Mailing Address - Country:US
Mailing Address - Phone:267-975-3412
Mailing Address - Fax:
Practice Address - Street 1:184 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2815
Practice Address - Country:US
Practice Address - Phone:215-247-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2017-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP008813224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant