Provider Demographics
NPI:1710479613
Name:SHEIN, AYE MYAT HTET (PHARMD)
Entity Type:Individual
Prefix:
First Name:AYE
Middle Name:MYAT HTET
Last Name:SHEIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 VAN KLEECK ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4221
Mailing Address - Country:US
Mailing Address - Phone:917-868-4680
Mailing Address - Fax:
Practice Address - Street 1:4116 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-2968
Practice Address - Country:US
Practice Address - Phone:718-777-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI063898-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist