Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 40QA01654200 | NJ |
Y | 226300000X | Kinesiotherapist |
NPI | 1659733848 |
---|---|
Provider Name | Ms. Sheryll Baranda Bajamundi |
First Address | Rahway, NJ 07065-2764 |
Second Address | Rahway, NJ 07065-2764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2016 |
Last Update Date | 25/03/2016 |