Provider Demographics
NPI:1356860563
Name:PAHANG, SHEILA MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
Last Name:PAHANG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452
Mailing Address - Country:US
Mailing Address - Phone:718-538-8343
Mailing Address - Fax:718-228-3771
Practice Address - Street 1:1221 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-3301
Practice Address - Country:US
Practice Address - Phone:718-538-8343
Practice Address - Fax:718-228-3771
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008777-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant