Healthcare Provider Details

I. General information

NPI: 1851238653
Provider Name (Legal Business Name): GURDAYA SIDHU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 ASTORIA BLVD
ASTORIA NY
11102-4468
US

IV. Provider business mailing address

2309 ASTORIA BLVD
ASTORIA NY
11102-4468
US

V. Phone/Fax

Practice location:
  • Phone: 347-813-8819
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number101YM0800X
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: