Provider Demographics
NPI:1063587988
Name:CAJITA, SHELLA ZARAGOZA (PT)
Entity type:Individual
Prefix:
First Name:SHELLA
Middle Name:ZARAGOZA
Last Name:CAJITA
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 1:481A FR. CAPODANNO BLVD.
Mailing Address - Street 2:STE. 1
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-720-3790
Mailing Address - Fax:718-720-1238
Practice Address - Street 1:845 BROAD AVE
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-1055
Practice Address - Country:US
Practice Address - Phone:908-301-6134
Practice Address - Fax:908-301-6586
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH04850Medicare ID - Type Unspecified