Provider Demographics
NPI:1922377381
Name:SHEIKH, SAMINA AMJAD (MASTERS IN EDUCATION)
Entity Type:Individual
Prefix:
First Name:SAMINA
Middle Name:AMJAD
Last Name:SHEIKH
Suffix:
Gender:F
Credentials:MASTERS IN EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11712 OCEAN PROMENADE
Mailing Address - Street 2:APT. 5G
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2040
Mailing Address - Country:US
Mailing Address - Phone:347-435-4285
Mailing Address - Fax:
Practice Address - Street 1:11712 OCEAN PROMENADE
Practice Address - Street 2:APT 5G
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2040
Practice Address - Country:US
Practice Address - Phone:347-435-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY857980174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY242424Medicaid