Provider Demographics
NPI:1386952984
Name:SHIRDAN, TARAYA J
Entity type:Individual
Prefix:
First Name:TARAYA
Middle Name:J
Last Name:SHIRDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:PILGRIM GARDENS
Mailing Address - State:PA
Mailing Address - Zip Code:19026-7706
Mailing Address - Country:US
Mailing Address - Phone:610-853-9919
Mailing Address - Fax:
Practice Address - Street 1:3300 TOWNSHIP LINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1925
Practice Address - Country:US
Practice Address - Phone:610-853-9919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001933239Medicaid