Provider Demographics
NPI:1598341752
Name:ABBELARD, SHIRLEY AIME
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:AIME
Last Name:ABBELARD
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 1:595 JEFFERSON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-1138
Mailing Address - Country:US
Mailing Address - Phone:908-956-5214
Mailing Address - Fax:
Practice Address - Street 1:470 NEW DORP LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4914
Practice Address - Country:US
Practice Address - Phone:908-956-5214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025465225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist