Provider Demographics
NPI:1437653045
Name:SHAYESTEHFROUZ, SARA (OTR/L)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SHAYESTEHFROUZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CLUB DR APT 2ER
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2075
Mailing Address - Country:US
Mailing Address - Phone:973-405-4118
Mailing Address - Fax:
Practice Address - Street 1:49 AVENUE T
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3501
Practice Address - Country:US
Practice Address - Phone:718-714-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022277225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist