Provider Demographics
NPI:1770764680
Name:SHAMIM, SHAHID (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:SHAHID
Middle Name:
Last Name:SHAMIM
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 174TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1539
Mailing Address - Country:US
Mailing Address - Phone:917-406-6366
Mailing Address - Fax:718-357-0036
Practice Address - Street 1:5910 174TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1539
Practice Address - Country:US
Practice Address - Phone:718-357-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy