Provider Demographics
NPI:1851930812
Name:THANIGAIVELU, SHYLASRI
Entity Type:Individual
Prefix:
First Name:SHYLASRI
Middle Name:
Last Name:THANIGAIVELU
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 1:87A TIERNEY DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1954
Mailing Address - Country:US
Mailing Address - Phone:201-723-9423
Mailing Address - Fax:
Practice Address - Street 1:21 S SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2624
Practice Address - Country:US
Practice Address - Phone:201-712-9113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-22
Last Update Date:2019-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01643900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist