Provider Demographics
NPI:1235971854
Name:SHADIA ISLAM
Entity type:Organization
Organization Name:SHADIA ISLAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-659-6647
Mailing Address - Street 1:7518 97TH AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-1024
Mailing Address - Country:US
Mailing Address - Phone:347-659-6647
Mailing Address - Fax:
Practice Address - Street 1:7518 97TH AVE FL 1
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-1024
Practice Address - Country:US
Practice Address - Phone:347-659-6647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)