Provider Demographics
NPI:1659696938
Name:HANIF, THAWHERA WAZIFA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:THAWHERA
Middle Name:WAZIFA
Last Name:HANIF
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LARRY RD
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2307
Mailing Address - Country:US
Mailing Address - Phone:631-880-3358
Mailing Address - Fax:
Practice Address - Street 1:21 LARRY RD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2307
Practice Address - Country:US
Practice Address - Phone:631-880-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014461-1172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker