Provider Demographics
NPI:1679311773
Name:MAQSUDI, SHAIRA
Entity type:Individual
Prefix:
First Name:SHAIRA
Middle Name:
Last Name:MAQSUDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3924
Mailing Address - Country:US
Mailing Address - Phone:516-943-3140
Mailing Address - Fax:
Practice Address - Street 1:111 S FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3924
Practice Address - Country:US
Practice Address - Phone:516-943-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency