Provider Demographics
NPI:1558674291
Name:MATHEW, SHYLA J (RPH)
Entity Type:Individual
Prefix:
First Name:SHYLA
Middle Name:J
Last Name:MATHEW
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SHYLA
Other - Middle Name:
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:23 RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4748
Mailing Address - Country:US
Mailing Address - Phone:410-814-9350
Mailing Address - Fax:
Practice Address - Street 1:12202 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2114
Practice Address - Country:US
Practice Address - Phone:718-843-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054578183500000X
MD17608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist