Healthcare Provider Details

I. General information

NPI: 1134031347
Provider Name (Legal Business Name): SHOSHANA KURAYEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8436 117TH ST
RICHMOND HILL NY
11418-1401
US

IV. Provider business mailing address

8436 117TH ST
RICHMOND HILL NY
11418-1401
US

V. Phone/Fax

Practice location:
  • Phone: 929-442-1055
  • Fax:
Mailing address:
  • Phone: 929-442-1055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number957745
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: