Provider Demographics
NPI:1265044606
Name:LEGHARI, SHAHRUKH
Entity Type:Individual
Prefix:MR
First Name:SHAHRUKH
Middle Name:
Last Name:LEGHARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LYNCH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTN STA
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2510
Mailing Address - Country:US
Mailing Address - Phone:347-571-1225
Mailing Address - Fax:
Practice Address - Street 1:225 BROADHOLLOW RD STE 402
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4899
Practice Address - Country:US
Practice Address - Phone:778-063-1385
Practice Address - Fax:631-385-7795
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst