Provider Demographics
NPI:1174886634
Name:RAHIM, SHANEEZA (MSED/TSHH)
Entity type:Individual
Prefix:MISS
First Name:SHANEEZA
Middle Name:
Last Name:RAHIM
Suffix:
Gender:F
Credentials:MSED/TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89-10 181 ST STREET
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423
Mailing Address - Country:US
Mailing Address - Phone:917-972-6950
Mailing Address - Fax:
Practice Address - Street 1:8910 181ST ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1730
Practice Address - Country:US
Practice Address - Phone:917-972-6950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist