Provider Demographics
NPI:1982876876
Name:PESTA, SHEILA FAITH ICAMEN (PT)
Entity Type:Individual
Prefix:
First Name:SHEILA FAITH
Middle Name:ICAMEN
Last Name:PESTA
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 1:1195 ECHO PL
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-4915
Mailing Address - Country:US
Mailing Address - Phone:732-286-0802
Mailing Address - Fax:
Practice Address - Street 1:600 S LIVINGSTON AVE STE 210
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5415
Practice Address - Country:US
Practice Address - Phone:800-530-3247
Practice Address - Fax:973-740-9007
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA00972400225100000X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics