Healthcare Provider Details

I. General information

NPI: 1780046573
Provider Name (Legal Business Name): PRIYANKA THAPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 62ND ST APT 2F
WOODSIDE NY
11377-4995
US

IV. Provider business mailing address

1243 E BRICKYARD RD APT 449
MILLCREEK UT
84106-5625
US

V. Phone/Fax

Practice location:
  • Phone: 917-306-5714
  • Fax:
Mailing address:
  • Phone: 917-306-5714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13249354-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: