Healthcare Provider Details

I. General information

NPI: 1063339190
Provider Name (Legal Business Name): SHABATHYAH CHARLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10818 225TH ST
QUEENS VILLAGE NY
11429-2834
US

IV. Provider business mailing address

10818 225TH ST
QUEENS VILLAGE NY
11429-2834
US

V. Phone/Fax

Practice location:
  • Phone: 347-465-8244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: