Provider Demographics
NPI:1366088106
Name:SCOTT, SHATEVA (MS)
Entity type:Individual
Prefix:
First Name:SHATEVA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14609 LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-5401
Mailing Address - Country:US
Mailing Address - Phone:516-589-5794
Mailing Address - Fax:
Practice Address - Street 1:14609 LAKEWOOD AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-5401
Practice Address - Country:US
Practice Address - Phone:516-589-5794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist