Provider Demographics
NPI:1780277707
Name:EL-SHAHAT, MONA I
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:I
Last Name:EL-SHAHAT
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 1:21 NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4333
Mailing Address - Country:US
Mailing Address - Phone:917-607-5556
Mailing Address - Fax:
Practice Address - Street 1:20934 NORTHERN BLVD # 1020
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3149
Practice Address - Country:US
Practice Address - Phone:848-999-4872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-20
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health