Provider Demographics
NPI:1134816309
Name:SHISTER-HAHN, YEVGENIYA (COTA/L)
Entity type:Individual
Prefix:
First Name:YEVGENIYA
Middle Name:
Last Name:SHISTER-HAHN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2765 STRICKLAND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6428
Mailing Address - Country:US
Mailing Address - Phone:917-774-2266
Mailing Address - Fax:
Practice Address - Street 1:376 BAY 44TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-7103
Practice Address - Country:US
Practice Address - Phone:718-906-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008404224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant