Provider Demographics
NPI:1023510237
Name:SHANKAR, VRUNDA (COTA)
Entity type:Individual
Prefix:MRS
First Name:VRUNDA
Middle Name:
Last Name:SHANKAR
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LANE RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1153
Mailing Address - Country:US
Mailing Address - Phone:908-271-4274
Mailing Address - Fax:
Practice Address - Street 1:100 HOLLINSHEAD SPRING RD
Practice Address - Street 2:
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-2028
Practice Address - Country:US
Practice Address - Phone:609-683-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-03
Last Update Date:2018-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09151000224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant