Healthcare Provider Details

I. General information

NPI: 1811862246
Provider Name (Legal Business Name): ANGELINA ANURADHA DEONARINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 66TH RD
FOREST HILLS NY
11375-2029
US

IV. Provider business mailing address

10201 66TH RD
FOREST HILLS NY
11375-2029
US

V. Phone/Fax

Practice location:
  • Phone: 718-830-4000
  • Fax:
Mailing address:
  • Phone: 718-830-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number034496
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: