Provider Demographics
NPI:1932556495
Name:RAFEEQ, ALYSHA R
Entity type:Individual
Prefix:MS
First Name:ALYSHA
Middle Name:R
Last Name:RAFEEQ
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 1:21304 94TH AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1608
Mailing Address - Country:US
Mailing Address - Phone:646-725-4637
Mailing Address - Fax:
Practice Address - Street 1:21304 94TH AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1608
Practice Address - Country:US
Practice Address - Phone:646-725-4637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-15
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst