Provider Demographics
NPI:1275779803
Name:BAWAYAN, SHERYL DIAZ (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:DIAZ
Last Name:BAWAYAN
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 1:7901 BROADWAY # D2-26
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1329
Mailing Address - Country:US
Mailing Address - Phone:718-334-2611
Mailing Address - Fax:718-334-5006
Practice Address - Street 1:7901 BROADWAY # D2-26
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-2611
Practice Address - Fax:718-334-5006
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-03
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014920225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist