Healthcare Provider Details

I. General information

NPI: 1497293831
Provider Name (Legal Business Name): TERSHA GRIFFITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22219 LINDEN BLVD
JAMAICA NY
11411-1605
US

IV. Provider business mailing address

PO BOX 746087
ATLANTA GA
30374-6087
US

V. Phone/Fax

Practice location:
  • Phone: 718-765-6055
  • Fax: 347-808-4948
Mailing address:
  • Phone: 312-733-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number307756
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number307756
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: