Provider Demographics
NPI:1639817265
Name:SHAHAR, IFAT JACQUELINE (MED, RCEP, CDCEC)
Entity Type:Individual
Prefix:MRS
First Name:IFAT
Middle Name:JACQUELINE
Last Name:SHAHAR
Suffix:
Gender:F
Credentials:MED, RCEP, CDCEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 FLORENCE ST APT C
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1937
Mailing Address - Country:US
Mailing Address - Phone:857-891-6190
Mailing Address - Fax:
Practice Address - Street 1:116 FLORENCE ST APT C
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1937
Practice Address - Country:US
Practice Address - Phone:857-891-6190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1000239224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist