Provider Demographics
NPI:1467714659
Name:SAJID-SHAH, ILEAN (MS ED)
Entity Type:Individual
Prefix:
First Name:ILEAN
Middle Name:
Last Name:SAJID-SHAH
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CEDAR ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5247
Mailing Address - Country:US
Mailing Address - Phone:914-576-5292
Mailing Address - Fax:
Practice Address - Street 1:1376 MIDLAND AVE
Practice Address - Street 2:APT. 610
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-6891
Practice Address - Country:US
Practice Address - Phone:914-356-0961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY626886174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist