Provider Demographics
NPI:1144300120
Name:MARIANO, SHALIMAR (PT)
Entity type:Individual
Prefix:MISS
First Name:SHALIMAR
Middle Name:
Last Name:MARIANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SHALIMAR
Other - Middle Name:
Other - Last Name:MARIANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:8615 AVA PL APT 6G
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2956
Mailing Address - Country:US
Mailing Address - Phone:646-541-8131
Mailing Address - Fax:718-297-3011
Practice Address - Street 1:8811 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2039
Practice Address - Country:US
Practice Address - Phone:718-847-4222
Practice Address - Fax:718-441-4117
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist