Provider Demographics
NPI:1144881269
Name:SHAPIRO BIVAS, AYALAH
Entity type:Individual
Prefix:MS
First Name:AYALAH
Middle Name:
Last Name:SHAPIRO BIVAS
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 1:1751 2ND AVE APT 5A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5376
Mailing Address - Country:US
Mailing Address - Phone:917-935-9641
Mailing Address - Fax:
Practice Address - Street 1:1751 2ND AVENUE
Practice Address - Street 2:SUITE #102
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:917-935-9641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001046102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst