Provider Demographics
NPI:1396334702
Name:WAHEED, AMNA
Entity type:Individual
Prefix:
First Name:AMNA
Middle Name:
Last Name:WAHEED
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 1:5023 65TH PL APT 1F
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11377
Mailing Address - Country:US
Mailing Address - Phone:929-329-7852
Mailing Address - Fax:
Practice Address - Street 1:11502 OCEAN PROMENADE
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2412
Practice Address - Country:US
Practice Address - Phone:718-634-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty