Provider Demographics
NPI:1255971503
Name:SOLED, SHIRA
Entity type:Individual
Prefix:
First Name:SHIRA
Middle Name:
Last Name:SOLED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 RUTHERFORD BLVD # 2
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014-1408
Mailing Address - Country:US
Mailing Address - Phone:310-720-4236
Mailing Address - Fax:
Practice Address - Street 1:98 RUTHERFORD BLVD # 2
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1408
Practice Address - Country:US
Practice Address - Phone:310-720-4236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty