Provider Demographics
NPI:1235486127
Name:SHIFER, RAIZY CHANA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:RAIZY
Middle Name:CHANA
Last Name:SHIFER
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7102
Mailing Address - Country:US
Mailing Address - Phone:718-375-8688
Mailing Address - Fax:
Practice Address - Street 1:1520 E 12TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7102
Practice Address - Country:US
Practice Address - Phone:718-375-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY457306041390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program