MEDICARE: SHAHEDA QURAISHI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	226282	NY
2	174400000X	Specialist	226282	NY
3	208100000X	Physical Medicine & Rehabilitation Physician	226282	NY

General Provider Information

NPI Number	:	1376581835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAHEDA QURAISHI MD

Provider Business Mailing Address
First Line	:	611 NORTHERN BLVD.
Second Line	:	SUITE 150
City	:	GREAT NECK
State	:	NY
Zip	:	11021
Country	:	US
Telephone Number	:	516-325-7000
Fax Number	:	516-325-7001

Provider Business Practice Location Address
First Line	:	611 NORTHERN BLVD
Second Line	:	SUITE 150
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5207
Country	:	US
Telephone Number	:	516-325-7000
Fax Number	:	516-325-7001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	03/02/2021

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