Provider Demographics
NPI:1801104187
Name:PASCUAL, SHIELA VILLANUEVA (OT)
Entity type:Individual
Prefix:
First Name:SHIELA
Middle Name:VILLANUEVA
Last Name:PASCUAL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 COPELAND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-3033
Mailing Address - Country:US
Mailing Address - Phone:847-873-3835
Mailing Address - Fax:
Practice Address - Street 1:245 COPELAND AVE APT 3
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-3033
Practice Address - Country:US
Practice Address - Phone:847-873-3835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014935225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist