Provider Demographics
NPI:1154647667
Name:MATHEW, SHEENA (RPH)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1509
Mailing Address - Country:US
Mailing Address - Phone:201-244-5606
Mailing Address - Fax:
Practice Address - Street 1:1870 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5473
Practice Address - Country:US
Practice Address - Phone:718-294-5588
Practice Address - Fax:718-294-5589
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054076-1183500000X
NJ28RI02769200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist