Provider Demographics
NPI:1447076450
Name:ANANNYA, FORTUNA RASHID (OTR/L)
Entity type:Individual
Prefix:
First Name:FORTUNA
Middle Name:RASHID
Last Name:ANANNYA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 18TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1094
Mailing Address - Country:US
Mailing Address - Phone:718-690-4185
Mailing Address - Fax:
Practice Address - Street 1:16 18TH ST
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1094
Practice Address - Country:US
Practice Address - Phone:718-690-4185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist