Healthcare Provider Details

I. General information

NPI: 1508532581
Provider Name (Legal Business Name): KHEVSI PLISHTIYEVA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10255 63RD RD
FOREST HILLS NY
11375-1048
US

IV. Provider business mailing address

7503 192ND ST
FRESH MEADOWS NY
11366-1859
US

V. Phone/Fax

Practice location:
  • Phone: 347-201-4664
  • Fax:
Mailing address:
  • Phone: 347-571-3963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF353473-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: