Healthcare Provider Details

I. General information

NPI: 1497659098
Provider Name (Legal Business Name): ANCHOR NP IN PSYCHIATRY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 S SERVICE RD STE 100
MELVILLE NY
11747-2350
US

IV. Provider business mailing address

68 S SERVICE RD STE 100
MELVILLE NY
11747-2350
US

V. Phone/Fax

Practice location:
  • Phone: 516-316-4689
  • Fax: 925-281-2589
Mailing address:
  • Phone: 516-316-4689
  • Fax: 925-281-2589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. AVESTA MIRIAM KHURSAND
Title or Position: PROVIDER
Credential: NP
Phone: 516-316-4689