Healthcare Provider Details

I. General information

NPI: 1801585559
Provider Name (Legal Business Name): SHAGHAYEGH JAVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 VAN WYCK EXPRESSWAY
QUEENS NY
11418
US

IV. Provider business mailing address

8900 VAN WYCK EXPRESSWAY
JAMAICA NY
11418
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-6000
  • Fax:
Mailing address:
  • Phone: 718-206-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA208027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: