Provider Demographics
NPI:1497159008
Name:SUNNYVALE PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:SUNNYVALE PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REMONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDEL-SHAHID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-275-4700
Mailing Address - Street 1:2912 BRIGHTON 12TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4722
Mailing Address - Country:US
Mailing Address - Phone:718-975-4334
Mailing Address - Fax:718-975-4337
Practice Address - Street 1:6860 AUSTIN ST STE 404
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4219
Practice Address - Country:US
Practice Address - Phone:718-275-4700
Practice Address - Fax:718-274-4744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty