Provider Demographics
NPI:1093539413
Name:SHAFIQUE VENTURA, YASMIN NAIDA
Entity type:Individual
Prefix:
First Name:YASMIN
Middle Name:NAIDA
Last Name:SHAFIQUE VENTURA
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 1:14 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2518
Mailing Address - Country:US
Mailing Address - Phone:516-312-0178
Mailing Address - Fax:
Practice Address - Street 1:595 PORTION RD STE D
Practice Address - Street 2:
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4599
Practice Address - Country:US
Practice Address - Phone:631-759-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029661-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist