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General NPI Number Information
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NPI Number | 1760959530
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Entity Type | Individual
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Provider Name | KISHA JEGEDE-GABBIDON FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 11208 SPRINGFIELD BLVD
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City | QUEENS VILLAGE
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State | NY
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Zip | 11429-2650
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Country | US
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Telephone | 929-430-3811
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Fax |
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Provider Business Mailing Address
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Address Line | 2417 JERICHO TPKE STE 279
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City | GARDEN CITY PARK
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State | NY
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Zip | 11040-4710
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Country | US
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Telephone | 929-430-3811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F338617-1
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License Number State | NY
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