Healthcare Provider Details

I. General information

NPI: 1801557178
Provider Name (Legal Business Name): SUKHJIT KAUR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 W 80TH ST FL 4 STE 15
NEW YORK NY
10024-5705
US

IV. Provider business mailing address

2248 BROADWAY STE 1329
NEW YORK NY
10024-5805
US

V. Phone/Fax

Practice location:
  • Phone: 315-505-2400
  • Fax: 914-505-2458
Mailing address:
  • Phone: 315-505-2400
  • Fax: 315-505-2458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF348503-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348503-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: