Provider Demographics
NPI:1598020687
Name:HYDER, TAHERA (MSED)
Entity Type:Individual
Prefix:
First Name:TAHERA
Middle Name:
Last Name:HYDER
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 RAMS HILL RD
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD LANDING
Mailing Address - State:NY
Mailing Address - Zip Code:11547-3016
Mailing Address - Country:US
Mailing Address - Phone:718-938-8045
Mailing Address - Fax:718-464-2017
Practice Address - Street 1:12 RAMS HILL RD
Practice Address - Street 2:
Practice Address - City:GLENWOOD LANDING
Practice Address - State:NY
Practice Address - Zip Code:11547-3016
Practice Address - Country:US
Practice Address - Phone:718-938-8045
Practice Address - Fax:718-464-2017
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1770581174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist