Provider Demographics
NPI:1689044315
Name:SHALOM, NIVA
Entity Type:Individual
Prefix:
First Name:NIVA
Middle Name:
Last Name:SHALOM
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 1:200 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4873
Mailing Address - Country:US
Mailing Address - Phone:212-346-6868
Mailing Address - Fax:
Practice Address - Street 1:200 E 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4873
Practice Address - Country:US
Practice Address - Phone:212-346-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2021-04-07
Deactivation Date:2020-12-10
Deactivation Code:
Reactivation Date:2021-03-19
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY026920-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist