Provider Demographics
NPI:1629389119
Name:GANZ, SHAINDY (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHAINDY
Middle Name:
Last Name:GANZ
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 1:14740 73RD AVE
Mailing Address - Street 2:APTMT 3F
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2951
Mailing Address - Country:US
Mailing Address - Phone:718-268-0618
Mailing Address - Fax:718-268-0618
Practice Address - Street 1:14740 73RD AVE
Practice Address - Street 2:APTMT 3F
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2951
Practice Address - Country:US
Practice Address - Phone:718-268-0618
Practice Address - Fax:718-268-0618
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014864225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics