Healthcare Provider Details

I. General information

NPI: 1063101434
Provider Name (Legal Business Name): LARAIB SEHRISH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CAYUGA PARK LN
ITHACA NY
14850-1180
US

IV. Provider business mailing address

401 CAYUGA PARK LN
ITHACA NY
14850-1180
US

V. Phone/Fax

Practice location:
  • Phone: 607-277-4341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number345927-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: