Provider Demographics
NPI:1376581835
Name:QURAISHI, SHAHEDA (MD)
Entity Type:Individual
Prefix:
First Name:SHAHEDA
Middle Name:
Last Name:QURAISHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 NORTHERN BLVD.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-325-7000
Mailing Address - Fax:516-325-7001
Practice Address - Street 1:611 NORTHERN BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5207
Practice Address - Country:US
Practice Address - Phone:516-325-7000
Practice Address - Fax:516-325-7001
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2262822081P2900X, 174400000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No174400000XOther Service ProvidersSpecialist