Provider Demographics
NPI:1740079797
Name:KORABELNIK, SHANIE (LCAT)
Entity type:Individual
Prefix:
First Name:SHANIE
Middle Name:
Last Name:KORABELNIK
Suffix:
Gender:
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 W 111TH ST APT 4E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1805
Mailing Address - Country:US
Mailing Address - Phone:917-273-8166
Mailing Address - Fax:
Practice Address - Street 1:603 W 111TH ST APT 4E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1805
Practice Address - Country:US
Practice Address - Phone:917-273-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002867225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist