Healthcare Provider Details

I. General information

NPI: 1306451174
Provider Name (Legal Business Name): AMIRA NAHSHAL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2488 GRAND CONCOURSE
BRONX NY
10458-5203
US

IV. Provider business mailing address

83 MAIDEN LN
NEW YORK NY
10038-4812
US

V. Phone/Fax

Practice location:
  • Phone: 212-780-2500
  • Fax:
Mailing address:
  • Phone: 212-780-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number027884
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: