Provider Demographics
NPI:1780204396
Name:KARASICK, SHIRA GABRIELLE
Entity type:Individual
Prefix:
First Name:SHIRA
Middle Name:GABRIELLE
Last Name:KARASICK
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 1:101 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2617
Mailing Address - Country:US
Mailing Address - Phone:516-729-1659
Mailing Address - Fax:
Practice Address - Street 1:561 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2907
Practice Address - Country:US
Practice Address - Phone:516-483-7580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program