Healthcare Provider Details

I. General information

NPI: 1699657460
Provider Name (Legal Business Name): SHANJIDA HOQ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 QUEENS BLVD STE 400
FOREST HILLS NY
11375-7211
US

IV. Provider business mailing address

11835 QUEENS BLVD STE 400
FOREST HILLS NY
11375-7211
US

V. Phone/Fax

Practice location:
  • Phone: 347-725-1185
  • Fax:
Mailing address:
  • Phone: 347-725-1185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1478977211
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: