Provider Demographics
NPI:1962284521
Name:SHAMAEV, DANIEL (OTR)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SHAMAEV
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 NOCELLA CT
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3021
Mailing Address - Country:US
Mailing Address - Phone:347-706-5175
Mailing Address - Fax:
Practice Address - Street 1:415 NOCELLA CT
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3021
Practice Address - Country:US
Practice Address - Phone:347-706-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation