Healthcare Provider Details

I. General information

NPI: 1386377158
Provider Name (Legal Business Name): SHEBA A VARGHESE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 01/07/2023
Certification Date: 01/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

22 MICHAEL LN APT SUITE
NORTH NEW HYDE PARK NY
11040-1806
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-4600
  • Fax:
Mailing address:
  • Phone: 516-450-8991
  • Fax: 212-305-7439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349312
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: