=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487417440
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAHUWA MUKHERJEE FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2024
-----------------------------------------------------
Last Update Date | 01/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 SITTERLY RD STE 2300
-----------------------------------------------------
City | HALFMOON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12065-5686
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-579-2650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 GALA PL
-----------------------------------------------------
City | NISKAYUNA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12309-3153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-229-8057
-----------------------------------------------------
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 | F353396
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------