Provider Demographics
NPI:1700353018
Name:SHAKKOUR-PEREZ, HAYFA (RT)
Entity type:Individual
Prefix:
First Name:HAYFA
Middle Name:
Last Name:SHAKKOUR-PEREZ
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W ENTERPRISE ST
Mailing Address - Street 2:
Mailing Address - City:GLEN LYON
Mailing Address - State:PA
Mailing Address - Zip Code:18617-1001
Mailing Address - Country:US
Mailing Address - Phone:570-764-1560
Mailing Address - Fax:
Practice Address - Street 1:55 3RD AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5723
Practice Address - Country:US
Practice Address - Phone:570-245-1532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAYM0100262279C0205X, 227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care