Provider Demographics
NPI:1942883715
Name:ETWAROO, SHAIDA A (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHAIDA
Middle Name:A
Last Name:ETWAROO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHAIDA
Other - Middle Name:A
Other - Last Name:MOHAMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12411 103RD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2107
Mailing Address - Country:US
Mailing Address - Phone:646-416-2808
Mailing Address - Fax:
Practice Address - Street 1:12411 103RD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2107
Practice Address - Country:US
Practice Address - Phone:646-416-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY514168163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse