Provider Demographics
NPI:1346669330
Name:MAZEL, SHIRA (OTR)
Entity Type:Individual
Prefix:
First Name:SHIRA
Middle Name:
Last Name:MAZEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:SHIRA
Other - Middle Name:
Other - Last Name:ZINBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:1 CLUB DR
Mailing Address - Street 2:APT. 1HR
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2054
Mailing Address - Country:US
Mailing Address - Phone:516-398-8133
Mailing Address - Fax:
Practice Address - Street 1:1 CLUB DR
Practice Address - Street 2:APT. 1HR
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2054
Practice Address - Country:US
Practice Address - Phone:516-398-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0185291251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)