Individual
SHANELLA JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3391 RICHMOND AVE, STATEN ISLAND, NY 10312-2025
(718) 608-9170
Mailing address
810 27TH AVE APT 717, ASTORIA, NY 11102-3962
(347) 209-7173
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
027718
NY
Other
Enumeration date
02/21/2023
Last updated
02/21/2023
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