Healthcare Provider Details

I. General information

NPI: 1568305167
Provider Name (Legal Business Name): ASHRAKAT MOHAMED MOHAMED SHAA DEYAB MBBCH/MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 10TH AVE
BROOKLYN NY
11219
US

IV. Provider business mailing address

505 57TH STREET APARTMENT 25
WEST NEW YORK NJ
07093
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-6000
  • Fax:
Mailing address:
  • Phone: 984-381-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: