Healthcare Provider Details

I. General information

NPI: 1629562780
Provider Name (Legal Business Name): JAISHREE MEKHURI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14243 123 AVE
JAMIACA NY
11436
US

IV. Provider business mailing address

14243 123RD AVE
JAMAICA NY
11436-1429
US

V. Phone/Fax

Practice location:
  • Phone: 347-444-7846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: