Provider Demographics
NPI:1801336565
Name:SHERZADA, SAHAR
Entity type:Individual
Prefix:
First Name:SAHAR
Middle Name:
Last Name:SHERZADA
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 1:197 COTTAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5947
Mailing Address - Country:US
Mailing Address - Phone:646-462-0096
Mailing Address - Fax:
Practice Address - Street 1:197 COTTAGE BLVD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5947
Practice Address - Country:US
Practice Address - Phone:646-462-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1279832390200000X
NY1034883162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program