Provider Demographics
NPI:1679042816
Name:SHEYDVASSER, BRIAN (PT,DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:SHEYDVASSER
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 ROUTE 9 N FL 4
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-1025
Mailing Address - Country:US
Mailing Address - Phone:201-807-7141
Mailing Address - Fax:
Practice Address - Street 1:12073 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-8306
Practice Address - Country:US
Practice Address - Phone:718-642-1100
Practice Address - Fax:718-642-9359
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ043768225100000X
NY043768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist