Provider Demographics
NPI:1205614690
Name:RAHEMTULLA, SHYROSE (CDP, ALF)
Entity type:Individual
Prefix:
First Name:SHYROSE
Middle Name:
Last Name:RAHEMTULLA
Suffix:
Gender:F
Credentials:CDP, ALF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 MEADOWLARK HILLS CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-1598
Mailing Address - Country:US
Mailing Address - Phone:908-230-5104
Mailing Address - Fax:
Practice Address - Street 1:21050 NORMANDY FOREST DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3281
Practice Address - Country:US
Practice Address - Phone:281-924-7173
Practice Address - Fax:844-201-0621
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102984376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator