Healthcare Provider Details

I. General information

NPI: 1710763701
Provider Name (Legal Business Name): ANNIE SHARITA JAHANGIR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15610 79TH ST APT 2
HOWARD BEACH NY
11414-2501
US

IV. Provider business mailing address

15610 79TH ST APT 2
HOWARD BEACH NY
11414-2501
US

V. Phone/Fax

Practice location:
  • Phone: 347-939-3103
  • Fax:
Mailing address:
  • Phone: 646-926-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: