Provider Demographics
NPI:1871738641
Name:SHELDON BANACH, RENAE AM
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:AM
Last Name:SHELDON BANACH
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 1:423 MAIN ST
Mailing Address - Street 2:OCCUPATIONAL THERAPY & HAND REHABILITATION
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2720
Mailing Address - Country:US
Mailing Address - Phone:716-366-3417
Mailing Address - Fax:
Practice Address - Street 1:423 MAIN ST
Practice Address - Street 2:OCCUPATIONAL THERAPY & HAND REHABILITATION
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2720
Practice Address - Country:US
Practice Address - Phone:716-366-3417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004737224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant