Basic Information
| Provider Information | |||||||||
| NPI: | 1790240166 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SHERPA | ||||||||
| FirstName: | ALISHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8901 31ST AVE | ||||||||
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| City: | EAST ELMHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113691749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6463590452 | ||||||||
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| Practice Location | |||||||||
| Address1: | 660 LOUISIANA AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112391526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186697100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2019 | ||||||||
| LastUpdateDate: | 02/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 023281-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | NJ23625K | 05 | NY | MEDICAID |