Basic Information
| Provider Information | |||||||||
| NPI: | 1376581835 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QURAISHI | ||||||||
| FirstName: | SHAHEDA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 NORTHERN BLVD. | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163257000 | ||||||||
| FaxNumber: | 5163257001 | ||||||||
| Practice Location | |||||||||
| Address1: | 611 NORTHERN BLVD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110215207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163257000 | ||||||||
| FaxNumber: | 5163257001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 03/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | 226282 | NY | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 174400000X | 226282 | NY | N | Other Service Providers | Specialist | 208100000X | 226282 | NY | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.