Healthcare Provider Details

I. General information

NPI: 1952283905
Provider Name (Legal Business Name): KSHAMA BARAICHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 LEXINGTON AVE
MOHEGAN LAKE NY
10547-1273
US

IV. Provider business mailing address

3550 LEXINGTON AVE
MOHEGAN LAKE NY
10547-1273
US

V. Phone/Fax

Practice location:
  • Phone: 914-528-2000
  • Fax:
Mailing address:
  • Phone: 914-528-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number312809
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number816139
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: