Healthcare Provider Details

I. General information

NPI: 1770402539
Provider Name (Legal Business Name): MRS. SHEENA MATHEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ROSE LN
NEW HYDE PARK NY
11040-1658
US

IV. Provider business mailing address

105 ROSE LN
NEW HYDE PARK NY
11040-1658
US

V. Phone/Fax

Practice location:
  • Phone: 631-385-7780
  • Fax: 631-385-7795
Mailing address:
  • Phone: 631-385-7780
  • Fax: 631-385-7795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: