Provider Demographics
NPI:1215698493
Name:MENZELLA, SHAUNA (DPT)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:MENZELLA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 STATE ROUTE 15
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:07848-2607
Mailing Address - Country:US
Mailing Address - Phone:973-862-6377
Mailing Address - Fax:973-862-6379
Practice Address - Street 1:156 STATE ROUTE 15
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:NJ
Practice Address - Zip Code:07848-2607
Practice Address - Country:US
Practice Address - Phone:973-862-6377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA020647002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics