=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629898432
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOGATASTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2024
-----------------------------------------------------
Last Update Date | 10/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34 HEMPSTEAD AVE
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550-4734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-306-6054
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 PARK BLVD
-----------------------------------------------------
City | MALVERNE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11565-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 191-730-6605
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NPP
-----------------------------------------------------
Name | AMALIA PER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 191-730-6605
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------