Healthcare Provider Details

I. General information

NPI: 1356994339
Provider Name (Legal Business Name): DEVIKA RACHEAL MIFFLIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MADISON AVE STE 1415
NEW YORK NY
10017-1111
US

IV. Provider business mailing address

415 MADISON AVE STE 1415
NEW YORK NY
10017-1111
US

V. Phone/Fax

Practice location:
  • Phone: 646-673-8415
  • Fax:
Mailing address:
  • Phone: 646-673-8415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number773455
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: