Provider Demographics
NPI:1932710357
Name:JAIN, SHALIKA (RPT)
Entity Type:Individual
Prefix:MS
First Name:SHALIKA
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 STATION DR
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798-3436
Mailing Address - Country:US
Mailing Address - Phone:516-374-6838
Mailing Address - Fax:516-374-2362
Practice Address - Street 1:2569 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4576
Practice Address - Country:US
Practice Address - Phone:718-332-3600
Practice Address - Fax:718-332-3856
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty