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General NPI Number Information
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NPI Number | 1811356082
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Entity Type | Individual
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Provider Name | SHEILA MANZOOR
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Gender | Female
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 611 NORTHERN BLVD SUITE 200
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City | GREAT NECK
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State | NY
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Zip | 11021-5207
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Country | US
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Telephone | 516-325-7115
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Fax |
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Provider Business Mailing Address
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Address Line | 15358 77TH AVE APT 1
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City | FLUSHING
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State | NY
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Zip | 11367-3152
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 019246-1
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License Number State | NY
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