Provider Demographics
NPI:1336833904
Name:USMAN, SIDRAH (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:SIDRAH
Middle Name:
Last Name:USMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 ROUTE 45 STE 106
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3521
Mailing Address - Country:US
Mailing Address - Phone:845-327-7111
Mailing Address - Fax:
Practice Address - Street 1:1039 COMMACK RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-8208
Practice Address - Country:US
Practice Address - Phone:516-641-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-23-65611103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty