Provider Demographics
NPI:1962162164
Name:MOHMEND, SAJIA
Entity type:Individual
Prefix:
First Name:SAJIA
Middle Name:
Last Name:MOHMEND
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 1:35 PRIMROSE AVE
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-1646
Mailing Address - Country:US
Mailing Address - Phone:917-293-8886
Mailing Address - Fax:
Practice Address - Street 1:35 PRIMROSE AVE
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1646
Practice Address - Country:US
Practice Address - Phone:917-293-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086686104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PCU01Other211745 EAGAN, MN 55121 EDI PAYER ID: PCU02