Provider Demographics
NPI:1902001092
Name:SCHAKTMAN, SHIRA ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHIRA
Middle Name:ELIZABETH
Last Name:SCHAKTMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SHIRA
Other - Middle Name:ELIZABETH
Other - Last Name:WALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:50 N TULANE ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-6912
Mailing Address - Country:US
Mailing Address - Phone:609-474-4824
Mailing Address - Fax:
Practice Address - Street 1:50 N TULANE ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-6912
Practice Address - Country:US
Practice Address - Phone:908-510-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100488300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical