Healthcare Provider Details

I. General information

NPI: 1801414180
Provider Name (Legal Business Name): SHAHERA MOHAMMED ELDEKEN I A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2822 43RD ST FL 1
ASTORIA NY
11103-2102
US

IV. Provider business mailing address

2822 43RD ST FL 1
ASTORIA NY
11103-2102
US

V. Phone/Fax

Practice location:
  • Phone: 929-666-0652
  • Fax:
Mailing address:
  • Phone: 929-666-0652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: