Provider Demographics
NPI:1811356082
Name:MANZOOR, SHEILA
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:MANZOOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:KARIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15358 77TH AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3152
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 NORTHERN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5207
Practice Address - Country:US
Practice Address - Phone:516-325-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019246-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant