Provider Demographics
NPI:1861261448
Name:DONATH, SHIRA DEBORAH (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHIRA
Middle Name:DEBORAH
Last Name:DONATH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SHIRA
Other - Middle Name:DEBORAH
Other - Last Name:KANDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1060 MAIN ST STE 306
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-2592
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1060 MAIN ST STE 306
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-2592
Practice Address - Country:US
Practice Address - Phone:201-614-4580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-25
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00733500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist