MEDICARE: SHASIA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	2445L001	NY

General Provider Information

NPI Number	:	1164959946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHASIA LLC

Provider Business Mailing Address
First Line	:	200 BROADHOLLOW RD STE 207
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-4806
Country	:	US
Telephone Number	:	631-393-5156
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 BROADHOLLOW RD STE 207
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-4806
Country	:	US
Telephone Number	:	631-393-5156
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SHASIA S CORRENTHI
Credential	:
Telephone Number	:	631-637-1270

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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