Provider Demographics
NPI:1922167733
Name:ANTHONY, SHAVONNE (MS)
Entity Type:Individual
Prefix:
First Name:SHAVONNE
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SHAVONNE
Other - Middle Name:
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9004 LINCOLN DR W STE F
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3206
Mailing Address - Country:US
Mailing Address - Phone:856-988-1160
Mailing Address - Fax:856-988-1183
Practice Address - Street 1:9004 LINCOLN DR W STE F
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3206
Practice Address - Country:US
Practice Address - Phone:856-988-1160
Practice Address - Fax:856-988-1183
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00361000225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics