Healthcare Provider Details

I. General information

NPI: 1912587833
Provider Name (Legal Business Name): SNEHA CHITTABATHINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 W JERICHO TPKE
HUNTINGTON STATION NY
11746-3627
US

IV. Provider business mailing address

19 W JERICHO TPKE
HUNTINGTON STATION NY
11746-3627
US

V. Phone/Fax

Practice location:
  • Phone: 631-604-4023
  • Fax:
Mailing address:
  • Phone:
  • 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 State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number329320
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: