Healthcare Provider Details

I. General information

NPI: 1437067261
Provider Name (Legal Business Name): TASHANI CLIFFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

6424 18TH AVE FL 2
BROOKLYN NY
11204-3729
US

IV. Provider business mailing address

124 LINDEN BLVD
BROOKLYN NY
11226-3301
US

V. Phone/Fax

Practice location:
  • Phone: 646-785-1316
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number357713
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: