Provider Demographics
NPI:1467700641
Name:SHERESHEVSKY, LAUREN MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MICHELLE
Last Name:SHERESHEVSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 E 68TH ST
Mailing Address - Street 2:APT. 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5760
Mailing Address - Country:US
Mailing Address - Phone:516-317-9720
Mailing Address - Fax:
Practice Address - Street 1:1265 E 68TH ST
Practice Address - Street 2:APT. 3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5760
Practice Address - Country:US
Practice Address - Phone:516-317-9720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics