Provider Demographics
NPI:1720527013
Name:VEDAD, SHEILA MAE
Entity Type:Individual
Prefix:
First Name:SHEILA MAE
Middle Name:
Last Name:VEDAD
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 1:20214 ROCKY HILL RD # J1
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3050
Mailing Address - Country:US
Mailing Address - Phone:929-329-6600
Mailing Address - Fax:
Practice Address - Street 1:8 MAPLE ST STE 9
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2963
Practice Address - Country:US
Practice Address - Phone:929-329-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist