Provider Demographics
NPI:1679324552
Name:WANMESBANSATIT, SHELIYA
Entity type:Individual
Prefix:
First Name:SHELIYA
Middle Name:
Last Name:WANMESBANSATIT
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 1:6313 60TH PL FL 2
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2029
Mailing Address - Country:US
Mailing Address - Phone:929-444-5010
Mailing Address - Fax:
Practice Address - Street 1:6313 60TH PL FL 2
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2029
Practice Address - Country:US
Practice Address - Phone:929-444-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033256225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist