Healthcare Provider Details

I. General information

NPI: 1255257721
Provider Name (Legal Business Name): TETHKAR AHMAD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 MYRTLE AVE FL 4
ALBANY NY
12208-3797
US

IV. Provider business mailing address

130 WINNIE ST
ALBANY NY
12208-2052
US

V. Phone/Fax

Practice location:
  • Phone: 518-207-2273
  • Fax:
Mailing address:
  • Phone: 518-253-6465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF359922-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: