Provider Demographics
NPI:1104859479
Name:ABDEL-SHAHID, REMONDA K (PT)
Entity Type:Individual
Prefix:
First Name:REMONDA
Middle Name:K
Last Name:ABDEL-SHAHID
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 FLORGATE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2010
Mailing Address - Country:US
Mailing Address - Phone:646-427-0353
Mailing Address - Fax:
Practice Address - Street 1:22 FLORGATE RD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2010
Practice Address - Country:US
Practice Address - Phone:646-427-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03139017Medicaid
NYA400016360Medicare PIN
NYA100016358Medicare PIN