Provider Demographics
NPI:1639522675
Name:JEWAN, SHEHREEN
Entity Type:Individual
Prefix:
First Name:SHEHREEN
Middle Name:
Last Name:JEWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WATER STREET
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0010
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:88-31 55TH AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4686
Practice Address - Country:US
Practice Address - Phone:718-899-6600
Practice Address - Fax:718-606-3881
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY302880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program