Healthcare Provider Details

I. General information

NPI: 1922925445
Provider Name (Legal Business Name): SHALLU JINDAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 CORNWELL AVE
WILLISTON PARK NY
11596-1536
US

IV. Provider business mailing address

176 CORNWELL AVE
WILLISTON PARK NY
11596-1536
US

V. Phone/Fax

Practice location:
  • Phone: 516-780-5016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF359897-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: