Provider Demographics
NPI:1437575487
Name:STEWART, SHANA (DPT)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 FIRST ST UNIT 8474
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-7531
Mailing Address - Country:US
Mailing Address - Phone:917-870-0041
Mailing Address - Fax:347-427-2312
Practice Address - Street 1:655 E 242ND ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1047
Practice Address - Country:US
Practice Address - Phone:917-870-0041
Practice Address - Fax:347-427-2312
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01228800225100000X
NY028331-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist