Provider Demographics
NPI:1063791283
Name:DUBASH, SHEHEREZAD MERZI (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:SHEHEREZAD
Middle Name:MERZI
Last Name:DUBASH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6254 97TH PL APT 3J
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1351
Mailing Address - Country:US
Mailing Address - Phone:732-861-5543
Mailing Address - Fax:646-839-2973
Practice Address - Street 1:531 50TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-6297
Practice Address - Country:US
Practice Address - Phone:732-861-5543
Practice Address - Fax:646-839-2973
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01402600225100000X
NY035574-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist