Healthcare Provider Details

I. General information

NPI: 1659281103
Provider Name (Legal Business Name): SANDY FAHMY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15645 84TH ST
HOWARD BEACH NY
11414-2645
US

IV. Provider business mailing address

8453 DANA CT APT 2B
MIDDLE VILLAGE NY
11379-1908
US

V. Phone/Fax

Practice location:
  • Phone: 718-464-5606
  • Fax: 718-280-2113
Mailing address:
  • Phone: 717-797-1255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number05577201
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: