Individual
MRS. SHAZIA I BASIR QUDDUSI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9777 QUEENS BLVD, PH, REGO PARK, NY 11374-3335
(718) 218-5439
(718) 228-4434
Mailing address
15 PRIMROSE AVE, HICKSVILLE, NY 11801-1617
(718) 218-5439
(718) 228-4434
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16472
SERVICE COORDINATION
NY
Enumeration date
06/13/2012
Last updated
06/13/2012
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