Provider Demographics
NPI:1952859217
Name:BHAIYAT, MOHAMMADEE
Entity Type:Individual
Prefix:
First Name:MOHAMMADEE
Middle Name:
Last Name:BHAIYAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 72ND ST
Mailing Address - Street 2:APT C1
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-4036
Mailing Address - Country:US
Mailing Address - Phone:347-392-8536
Mailing Address - Fax:
Practice Address - Street 1:111 JOHN ST RM 2400
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3013
Practice Address - Country:US
Practice Address - Phone:347-527-4320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY009986101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program