Provider Demographics
NPI:1346329158
Name:TRUMAN, SHAUNDELL NICOLA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SHAUNDELL
Middle Name:NICOLA
Last Name:TRUMAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
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Mailing Address - Street 1:1680 ALLEGHENY DR
Mailing Address - Street 2:
Mailing Address - City:BLAKESLEE
Mailing Address - State:PA
Mailing Address - Zip Code:18610-2203
Mailing Address - Country:US
Mailing Address - Phone:570-646-1109
Mailing Address - Fax:570-646-1109
Practice Address - Street 1:122 E 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4516
Practice Address - Country:US
Practice Address - Phone:212-677-7400
Practice Address - Fax:212-529-2071
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003925224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant