Provider Demographics
NPI:1487325783
Name:SHAYENA DONALDSON-FORTUNE OCCUPATIONAL THERAPY SERVICES, PLLC
Entity type:Organization
Organization Name:SHAYENA DONALDSON-FORTUNE OCCUPATIONAL THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAYENA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONALDSON-FORTUNE
Authorized Official - Suffix:
Authorized Official - Credentials:MSOT, OTR/L
Authorized Official - Phone:917-569-5129
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-0445
Mailing Address - Country:US
Mailing Address - Phone:917-569-5129
Mailing Address - Fax:
Practice Address - Street 1:100 LOTUS OVAL N
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-2328
Practice Address - Country:US
Practice Address - Phone:917-569-5129
Practice Address - Fax:516-792-6803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-26
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty