Individual
SHOSHANA FAWKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21540 41ST AVE UNIT 1J, BAYSIDE, NY 11361
(516) 319-6446
Mailing address
21540 41ST AVE UNIT 1J, BAYSIDE, NY 11361
(516) 319-6446
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
011862
NY
Other
Enumeration date
11/25/2008
Last updated
11/25/2008
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