Provider Demographics
NPI:1790497006
Name:MONTEFRIO, SHEENA MARIE TACANG
Entity Type:Individual
Prefix:
First Name:SHEENA MARIE
Middle Name:TACANG
Last Name:MONTEFRIO
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 1:510 MAIN ST APT 740
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0171
Mailing Address - Country:US
Mailing Address - Phone:631-882-1855
Mailing Address - Fax:
Practice Address - Street 1:2118 WILLIAMSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1602
Practice Address - Country:US
Practice Address - Phone:718-823-3900
Practice Address - Fax:718-823-3961
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist