Provider Demographics
NPI:1235497124
Name:SHAYEK, SOPHIA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:SHAYEK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2702
Mailing Address - Country:US
Mailing Address - Phone:917-716-5156
Mailing Address - Fax:
Practice Address - Street 1:300 ADELPHI ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-4601
Practice Address - Country:US
Practice Address - Phone:718-858-6291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist