Provider Demographics
NPI:1588250146
Name:SHAIKH, MOMINA AHMED (OD)
Entity type:Individual
Prefix:
First Name:MOMINA
Middle Name:AHMED
Last Name:SHAIKH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 HILLSIDE PL APT 2A
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-3130
Mailing Address - Country:US
Mailing Address - Phone:630-965-5197
Mailing Address - Fax:
Practice Address - Street 1:51 E PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2225
Practice Address - Country:US
Practice Address - Phone:914-721-5072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV009277-01152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist