Healthcare Provider Details

I. General information

NPI: 1629337696
Provider Name (Legal Business Name): SEVAN VAHANIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 1ST ST DEPT OF OB/GYN
MINEOLA NY
11501-3957
US

IV. Provider business mailing address

259 1ST ST DEPT OF OB/GYN
MINEOLA NY
11501-3957
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-3020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number273902
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number273902
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: