Provider Demographics
NPI:1508537846
Name:FONTANIVE, SHEILA (ATR-BC, LCAT)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:FONTANIVE
Suffix:
Gender:F
Credentials:ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 11TH AVE APT 9J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1231
Mailing Address - Country:US
Mailing Address - Phone:646-593-2857
Mailing Address - Fax:
Practice Address - Street 1:209 E 23RD ST RM 105
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3901
Practice Address - Country:US
Practice Address - Phone:646-593-2857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001652221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist