Healthcare Provider Details

I. General information

NPI: 1275344418
Provider Name (Legal Business Name): KEISHA SEWELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80-45 WINCHESTER BOULEVARD BUILDING 19
QUEENS VILLAGE NY
11427
US

IV. Provider business mailing address

80-45 WINCHESTER BOULEVARD BUILDING 19
QUEENS VILLAGE NY
11427-2194
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-3740
  • Fax: 718-264-3729
Mailing address:
  • Phone: 718-264-3740
  • Fax: 718-264-3729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406686
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: