Provider Demographics
NPI:1275654253
Name:MANSUKHANI, SHIRLEY (DPT)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:MANSUKHANI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 HARDING AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-3122
Mailing Address - Country:US
Mailing Address - Phone:917-981-9551
Mailing Address - Fax:
Practice Address - Street 1:2612 HARDING AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-3122
Practice Address - Country:US
Practice Address - Phone:917-981-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist