Provider Demographics
NPI:1962221549
Name:BHADORIA, SHAILESH
Entity type:Individual
Prefix:
First Name:SHAILESH
Middle Name:
Last Name:BHADORIA
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 1:2 CROSFIELD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2233
Mailing Address - Country:US
Mailing Address - Phone:973-887-9000
Mailing Address - Fax:973-695-1609
Practice Address - Street 1:2 CROSFIELD AVE STE 101
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2233
Practice Address - Country:US
Practice Address - Phone:973-887-9000
Practice Address - Fax:973-695-1609
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052016-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist