Provider Demographics
NPI:1801300199
Name:LEE, SHARIAH N (MS,OTR/L)
Entity type:Individual
Prefix:
First Name:SHARIAH
Middle Name:N
Last Name:LEE
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:SHARIAH
Other - Middle Name:N
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:97 REMSEN AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-1819
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:97 REMSEN AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-1819
Practice Address - Country:US
Practice Address - Phone:347-323-0792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021947225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY82-2876472OtherINDIVIDUAL CONTRACTOR