Provider Demographics
NPI:1780204396
Name:STAVSKY, SHIRA GABRIELLE
Entity Type:Individual
Prefix:
First Name:SHIRA
Middle Name:GABRIELLE
Last Name:STAVSKY
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 1:1485 E TERRACE CIR APT 4
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5219
Mailing Address - Country:US
Mailing Address - Phone:516-729-1659
Mailing Address - Fax:
Practice Address - Street 1:1485 E TERRACE CIR APT 4
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5219
Practice Address - Country:US
Practice Address - Phone:516-729-1659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program