Provider Demographics
NPI:1871168492
Name:GALLMAN, SHAVON KANISE (LMT)
Entity type:Individual
Prefix:MS
First Name:SHAVON
Middle Name:KANISE
Last Name:GALLMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:178 COLUMBUS AVE UNIT 230753
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-9629
Mailing Address - Country:US
Mailing Address - Phone:404-398-3015
Mailing Address - Fax:315-897-5478
Practice Address - Street 1:45 W 45TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4602
Practice Address - Country:US
Practice Address - Phone:347-763-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028284225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist