Provider Demographics
NPI:1609188465
Name:SHOAIB, SANIYA (OD)
Entity Type:Individual
Prefix:
First Name:SANIYA
Middle Name:
Last Name:SHOAIB
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 DRIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-6438
Mailing Address - Country:US
Mailing Address - Phone:718-349-1205
Mailing Address - Fax:718-389-3951
Practice Address - Street 1:284 DRIGGS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-6438
Practice Address - Country:US
Practice Address - Phone:718-349-1205
Practice Address - Fax:718-389-3951
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007541152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400048997OtherMEDICARE ID