Provider Demographics
NPI:1215166285
Name:KUPERSHTEYN, SHILAMIDA (LAC, MT)
Entity type:Individual
Prefix:
First Name:SHILAMIDA
Middle Name:
Last Name:KUPERSHTEYN
Suffix:
Gender:F
Credentials:LAC, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13-45 SPERBER RD
Mailing Address - Street 2:APT D
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-7362
Mailing Address - Country:US
Mailing Address - Phone:201-410-1756
Mailing Address - Fax:
Practice Address - Street 1:13-45 SPERBER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-7362
Practice Address - Country:US
Practice Address - Phone:201-410-1756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
NY004962-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist