Provider Demographics
NPI:1487916854
Name:KALMAN, SHANA BROOKE
Entity type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:BROOKE
Last Name:KALMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 WEST 246TH STREET
Mailing Address - Street 2:APT 334
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3633
Mailing Address - Country:US
Mailing Address - Phone:551-486-0062
Mailing Address - Fax:
Practice Address - Street 1:630 W 246TH ST
Practice Address - Street 2:APT 334
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-3631
Practice Address - Country:US
Practice Address - Phone:551-486-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1132392174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist