Provider Demographics
NPI:1437821477
Name:DEBIDEEN, SHAMILLA
Entity Type:Individual
Prefix:
First Name:SHAMILLA
Middle Name:
Last Name:DEBIDEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109-08 95TH AVENUE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419
Mailing Address - Country:US
Mailing Address - Phone:646-484-0660
Mailing Address - Fax:
Practice Address - Street 1:109-08 95TH AVENUE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419
Practice Address - Country:US
Practice Address - Phone:646-484-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY651787163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse