Provider Demographics
NPI:1588296099
Name:TEREBELO, SHOSHANA
Entity type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:
Last Name:TEREBELO
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 1:604 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1724
Mailing Address - Country:US
Mailing Address - Phone:516-376-7154
Mailing Address - Fax:
Practice Address - Street 1:604 PARK AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1724
Practice Address - Country:US
Practice Address - Phone:516-376-7154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant