MEDICARE: MS. SHYAN INDERA JAGDEO NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	309775	NY

General Provider Information

NPI Number	:	1205459534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHYAN INDERA JAGDEO NP

Provider Business Mailing Address
First Line	:	3224 ANCHOR DR
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-1602
Country	:	US
Telephone Number	:	718-450-6604
Fax Number	:	516-531-8944

Provider Business Practice Location Address
First Line	:	3224 ANCHOR DR
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-1602
Country	:	US
Telephone Number	:	718-450-6604
Fax Number	:	516-531-8944

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2020
Last Update Date	:	05/19/2026

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