Provider Demographics
NPI:1760662837
Name:BASHIR, SHAISTA
Entity type:Individual
Prefix:MS
First Name:SHAISTA
Middle Name:
Last Name:BASHIR
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 1:403 WILLIAM FLOYD PKWY
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-3473
Mailing Address - Country:US
Mailing Address - Phone:631-399-0700
Mailing Address - Fax:631-399-0773
Practice Address - Street 1:403 WILLIAM FLOYD PKWY
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-3473
Practice Address - Country:US
Practice Address - Phone:631-399-0700
Practice Address - Fax:631-399-0773
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist