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General NPI Number Information
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NPI Number | 1093539413
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Entity Type | Individual
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Provider Name | YASMIN NAIDA SHAFIQUE VENTURA
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Gender | Female
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 595 PORTION RD STE D
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City | LAKE RONKONKOMA
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State | NY
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Zip | 11779-4599
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Country | US
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Telephone | 631-759-5789
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Fax |
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Provider Business Mailing Address
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Address Line | 14 2ND AVE
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City | WESTBURY
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State | NY
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Zip | 11590-2518
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Country | US
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Telephone | 516-312-0178
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 029661-01
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License Number State | NY
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