Provider Demographics
NPI:1619409836
Name:SHEHATA, AHMED SR
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:SHEHATA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19840 32ND AVE APT B2
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1243
Mailing Address - Country:US
Mailing Address - Phone:347-613-7338
Mailing Address - Fax:
Practice Address - Street 1:19840 32ND AVE APT B2
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1243
Practice Address - Country:US
Practice Address - Phone:347-613-7338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2021-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist