Provider Demographics
NPI:1306233192
Name:SHALOMAYEV, NATALIA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:SHALOMAYEV
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9750 QUEENS BLVD
Mailing Address - Street 2:APT D8
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3252
Mailing Address - Country:US
Mailing Address - Phone:917-340-9435
Mailing Address - Fax:
Practice Address - Street 1:315 E 113TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2207
Practice Address - Country:US
Practice Address - Phone:917-340-9435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0194551225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist