Provider Demographics
NPI:1285684522
Name:SHELINSKY, KENNETH D (MS, PT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:D
Last Name:SHELINSKY
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4122
Mailing Address - Country:US
Mailing Address - Phone:203-655-6464
Mailing Address - Fax:203-655-2859
Practice Address - Street 1:264 HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4122
Practice Address - Country:US
Practice Address - Phone:203-655-6464
Practice Address - Fax:203-655-2859
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650001094Medicare ID - Type Unspecified