Healthcare Provider Details

I. General information

NPI: 1184050106
Provider Name (Legal Business Name): DR. VARSHA PERSAUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12202 LIBERTY AVE
SOUTH RICHMOND HILL NY
11419-2114
US

IV. Provider business mailing address

26018 83RD AVE
FLORAL PARK NY
11004-1702
US

V. Phone/Fax

Practice location:
  • Phone: 718-843-7001
  • Fax:
Mailing address:
  • Phone: 646-413-8373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number058528
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: