Provider Demographics
NPI:1417589987
Name:NOVAK, SHAYLYN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SHAYLYN
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BARRICKLO ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-6507
Mailing Address - Country:US
Mailing Address - Phone:609-337-0964
Mailing Address - Fax:
Practice Address - Street 1:650 GREAT RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2598
Practice Address - Country:US
Practice Address - Phone:609-924-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002278002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer