Provider Demographics
NPI:1356462840
Name:MOHABIR, AMELIA (RPA-C)
Entity Type:Individual
Prefix:MISS
First Name:AMELIA
Middle Name:
Last Name:MOHABIR
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MRS
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:WYDROWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:506 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3609
Mailing Address - Country:US
Mailing Address - Phone:718-780-3000
Mailing Address - Fax:
Practice Address - Street 1:150 MESEROLE STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:866-907-2308
Practice Address - Fax:248-855-5455
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007901363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant