Provider Demographics
NPI:1144634627
Name:SHAIK, VAHIDA BEGUM
Entity type:Individual
Prefix:
First Name:VAHIDA
Middle Name:BEGUM
Last Name:SHAIK
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 1:212 VILLAGE DR APT 1
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2637
Mailing Address - Country:US
Mailing Address - Phone:412-708-3778
Mailing Address - Fax:
Practice Address - Street 1:212 VILLAGE DR APT 1
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2637
Practice Address - Country:US
Practice Address - Phone:412-708-3778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist