Healthcare Provider Details

I. General information

NPI: 1942124599
Provider Name (Legal Business Name): KELLIANA SEERAJ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

100 PORT WASHINGTON BLVD
ROSLYN NY
11576-1347
US

IV. Provider business mailing address

10923 LEFFERTS BLVD
SOUTH OZONE PARK NY
11420-1342
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-6000
  • Fax:
Mailing address:
  • Phone: 347-421-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number036235-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: