Healthcare Provider Details

I. General information

NPI: 1699127522
Provider Name (Legal Business Name): NATASHA WEST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2016
Last Update Date: 09/09/2026
Certification Date: 02/10/2022
Deactivation Date: 02/10/2022
Reactivation Date: 09/09/2026

III. Provider practice location address

9125 BEDELL LN
BROOKLYN NY
11236-3242
US

IV. Provider business mailing address

9125 BEDELL LN
BROOKLYN NY
11236-3242
US

V. Phone/Fax

Practice location:
  • Phone: 347-675-5730
  • Fax:
Mailing address:
  • Phone: 347-675-5730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number48976
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: