Healthcare Provider Details

I. General information

NPI: 1831680990
Provider Name (Legal Business Name): SHARWAT JAHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7559 263RD ST
GLEN OAKS NY
11004-1150
US

IV. Provider business mailing address

7559 263RD ST
GLEN OAKS NY
11004-1150
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-3506
  • Fax:
Mailing address:
  • Phone: 718-470-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number316991
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: