Provider Demographics
NPI:1538607148
Name:SHALEV, DAVINA (PA)
Entity type:Individual
Prefix:MRS
First Name:DAVINA
Middle Name:
Last Name:SHALEV
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:DAVINA
Other - Middle Name:
Other - Last Name:WADLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:15910 71ST AVE
Mailing Address - Street 2:APT 8D
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3020
Mailing Address - Country:US
Mailing Address - Phone:917-561-2417
Mailing Address - Fax:
Practice Address - Street 1:520 E 70TH ST
Practice Address - Street 2:STARR PAVILION, SUITE 651
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-9800
Practice Address - Country:US
Practice Address - Phone:212-746-2363
Practice Address - Fax:212-746-7729
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant