Provider Demographics
NPI:1184869364
Name:SHEHATA, MAMDOUH AHMED (PT,DPT)
Entity type:Individual
Prefix:DR
First Name:MAMDOUH
Middle Name:AHMED
Last Name:SHEHATA
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ROSEBANK PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1845
Mailing Address - Country:US
Mailing Address - Phone:917-549-7537
Mailing Address - Fax:718-448-5711
Practice Address - Street 1:19 ROSEBANK PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1845
Practice Address - Country:US
Practice Address - Phone:917-549-7537
Practice Address - Fax:718-448-5711
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist