Healthcare Provider Details

I. General information

NPI: 1982929956
Provider Name (Legal Business Name): SHANTA SUBDHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 04/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9451 SPRINGFIELD BLVD
QUEENS VILLAGE NY
11428-2129
US

IV. Provider business mailing address

9451 SPRINGFIELD BLVD
QUEENS VILLAGE NY
11428-2129
US

V. Phone/Fax

Practice location:
  • Phone: 516-314-1321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: