Provider Demographics
NPI:1669737037
Name:SHEHADA, ALMUTASEMB M (PODIATRIST)
Entity type:Individual
Prefix:DR
First Name:ALMUTASEMB
Middle Name:M
Last Name:SHEHADA
Suffix:
Gender:M
Credentials:PODIATRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7708 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3312
Mailing Address - Country:US
Mailing Address - Phone:718-836-2111
Mailing Address - Fax:
Practice Address - Street 1:7708 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3312
Practice Address - Country:US
Practice Address - Phone:718-836-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006492213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine