Healthcare Provider Details

I. General information

NPI: 1003235839
Provider Name (Legal Business Name): SHAMAILA IDREES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 HEMPSTEAD TPKE
EAST MEADOW NY
11554-1859
US

IV. Provider business mailing address

3591 FAMS CT
LEVITTOWN NY
11756-4471
US

V. Phone/Fax

Practice location:
  • Phone: 516-572-6171
  • Fax:
Mailing address:
  • Phone: 631-721-5099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number314060
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: