Healthcare Provider Details

I. General information

NPI: 1932064391
Provider Name (Legal Business Name): SHAHREEN ISLAM RAISA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1657 SUNSET AVE
UTICA NY
13502-5415
US

IV. Provider business mailing address

8802 CINNAMON CREEK DR APT 1409
SAN ANTONIO TX
78240-4616
US

V. Phone/Fax

Practice location:
  • Phone: 646-739-7266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP140117
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: