Provider Demographics
NPI:1942575733
Name:SITARAM, SHERIZA SORAIYA (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:SHERIZA
Middle Name:SORAIYA
Last Name:SITARAM
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21443 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1711
Mailing Address - Country:US
Mailing Address - Phone:171-842-3831
Mailing Address - Fax:
Practice Address - Street 1:21443 35TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1711
Practice Address - Country:US
Practice Address - Phone:171-842-3831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011869-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist