=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376105163
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHEEJA KURIAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2019
-----------------------------------------------------
Last Update Date | 07/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 984 N BROADWAY
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10701-1318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-410-3633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 BALDWIN HILLS RD
-----------------------------------------------------
City | MILLWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10546-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F344192-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------