Provider Demographics
NPI:1629350061
Name:SHAULOVA, ANZHELA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANZHELA
Middle Name:
Last Name:SHAULOVA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 LEFFERTS BLVD APT 4G
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2544
Mailing Address - Country:US
Mailing Address - Phone:917-496-8067
Mailing Address - Fax:
Practice Address - Street 1:8315 LEFFERTS BLVD APT 4G
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2544
Practice Address - Country:US
Practice Address - Phone:917-496-8067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016085-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics