Provider Demographics
NPI:1558024539
Name:WINIARZ, SHALVA
Entity Type:Individual
Prefix:
First Name:SHALVA
Middle Name:
Last Name:WINIARZ
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 1:1527 60TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5023
Mailing Address - Country:US
Mailing Address - Phone:718-336-6073
Mailing Address - Fax:
Practice Address - Street 1:1527 60TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5023
Practice Address - Country:US
Practice Address - Phone:718-336-6073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator