Provider Demographics
NPI:1740750587
Name:SHAFIQUE, KIRAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KIRAN
Middle Name:
Last Name:SHAFIQUE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KIRAN
Other - Middle Name:
Other - Last Name:GHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:445 BROADWAY GREENLAWN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-5424
Mailing Address - Country:US
Mailing Address - Phone:347-602-3341
Mailing Address - Fax:
Practice Address - Street 1:1642 63RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-2744
Practice Address - Country:US
Practice Address - Phone:718-234-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022531225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY022531OtherOTR/L