Provider Demographics
NPI:1902818354
Name:JANDA, SHEILA (PT)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:JANDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 CRYSTAL RUN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-7000
Mailing Address - Country:US
Mailing Address - Phone:845-703-3070
Mailing Address - Fax:745-703-3072
Practice Address - Street 1:390 CRYSTAL RUN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-7000
Practice Address - Country:US
Practice Address - Phone:845-703-3070
Practice Address - Fax:745-703-3072
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015643-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQN703-1OtherORTHONET
NY826067OtherMPN
NYP2953214OtherOXFORD
NY4355552OtherMVP