Provider Demographics
NPI:1770738510
Name:GOLDSTEIN, SHANNA (PT)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 BLACKSTONE AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3716
Mailing Address - Country:US
Mailing Address - Phone:347-449-6529
Mailing Address - Fax:
Practice Address - Street 1:3950 BLACKSTONE AVE APT 1E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-3716
Practice Address - Country:US
Practice Address - Phone:347-449-6529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030779-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics