Healthcare Provider Details

I. General information

NPI: 1053230748
Provider Name (Legal Business Name): FNU MAHIMA SHARON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8359 264TH ST
GLEN OAKS NY
11004-1771
US

IV. Provider business mailing address

8528 258TH ST
FLORAL PARK NY
11001-1030
US

V. Phone/Fax

Practice location:
  • Phone: 718-395-2393
  • Fax: 516-746-1039
Mailing address:
  • Phone: 301-802-1746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number055866
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: