Provider Demographics
NPI:1356885040
Name:OMRAN, NOUR EL SHAM MOHAMED ABDALLA
Entity type:Individual
Prefix:MRS
First Name:NOUR EL SHAM
Middle Name:MOHAMED ABDALLA
Last Name:OMRAN
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 1:538 BROADHOLLOW ROAD SUITE 202
Mailing Address - Street 2:ACHIEVE BEYOND
Mailing Address - City:MEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:631-385-7780
Mailing Address - Fax:631-385-7795
Practice Address - Street 1:538 BROADHOLLOW ROAD SUITE 202
Practice Address - Street 2:ACHIEVE BEYOND
Practice Address - City:MEVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747
Practice Address - Country:US
Practice Address - Phone:631-385-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician