Provider Demographics
NPI:1255063970
Name:SHAULOV, SHARON (OTR/L)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:SHAULOV
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14350 HOOVER AVE APT 120
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2131
Mailing Address - Country:US
Mailing Address - Phone:718-570-4945
Mailing Address - Fax:
Practice Address - Street 1:14350 HOOVER AVE APT 120
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-2131
Practice Address - Country:US
Practice Address - Phone:718-570-4945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025374-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist