Provider Demographics
NPI:1760637128
Name:SHAPPAN, USAMA (PT)
Entity Type:Individual
Prefix:
First Name:USAMA
Middle Name:
Last Name:SHAPPAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 83RD ST # 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2816
Mailing Address - Country:US
Mailing Address - Phone:347-993-1270
Mailing Address - Fax:
Practice Address - Street 1:684 83RD ST # 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2816
Practice Address - Country:US
Practice Address - Phone:347-993-1270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017152-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor