Provider Demographics
NPI:1578823845
Name:CAUILAN, SHARON JOY BAJADO (PT)
Entity Type:Individual
Prefix:MS
First Name:SHARON JOY
Middle Name:BAJADO
Last Name:CAUILAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 175TH ST
Mailing Address - Street 2:4N
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5731
Mailing Address - Country:US
Mailing Address - Phone:646-331-9287
Mailing Address - Fax:
Practice Address - Street 1:8720 175TH ST
Practice Address - Street 2:4N
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5731
Practice Address - Country:US
Practice Address - Phone:646-331-9287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist