Healthcare Provider Details

I. General information

NPI: 1992623268
Provider Name (Legal Business Name): RAWATTIE BAHADOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 12TH ST
ASTORIA NY
11106-5057
US

IV. Provider business mailing address

3435 12TH ST APT 6A
ASTORIA NY
11106-5037
US

V. Phone/Fax

Practice location:
  • Phone: 516-737-1454
  • Fax:
Mailing address:
  • Phone: 917-251-7884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number005669
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: