Provider Demographics
NPI:1013266055
Name:SHAVIT, JOAN SANDRA (MS)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:SANDRA
Last Name:SHAVIT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:FISHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:347 GREENWICH AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:347 GREENWICH AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6505
Practice Address - Country:US
Practice Address - Phone:917-282-2687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY39OtherSTUDENT, HEALTH CARE