Healthcare Provider Details

I. General information

NPI: 1790414043
Provider Name (Legal Business Name): CHELSEA MOHAMMED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14015 SANFORD AVE STE B
FLUSHING NY
11355-2688
US

IV. Provider business mailing address

14015 SANFORD AVE STE B
FLUSHING NY
11355-2688
US

V. Phone/Fax

Practice location:
  • Phone: 718-358-8288
  • Fax:
Mailing address:
  • Phone: 347-932-2043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number014647
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: