Provider Demographics
NPI:1730906504
Name:AKTHER, SHELINA
Entity type:Individual
Prefix:
First Name:SHELINA
Middle Name:
Last Name:AKTHER
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 1:98 STEPHEN ST
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1719
Mailing Address - Country:US
Mailing Address - Phone:929-421-8841
Mailing Address - Fax:
Practice Address - Street 1:98 STEPHEN ST
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1719
Practice Address - Country:US
Practice Address - Phone:929-421-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1579120222106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty