MEDICARE: SHUBRATA DEY FNP

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	363LF0000X	Family Nurse Practitioner	11004216	FL
2	363LF0000X	Family Nurse Practitioner	349573	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457902058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHUBRATA DEY FNP

Provider Business Mailing Address
First Line	:	16410 NORTHERN BLVD STE 204
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-2668
Country	:	US
Telephone Number	:	718-886-2011
Fax Number	:	929-333-7950

Provider Business Practice Location Address
First Line	:	16410 NORTHERN BLVD STE 204
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-2668
Country	:	US
Telephone Number	:	718-886-2011
Fax Number	:	929-333-7950

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

Provider Enumeration Date	:	09/25/2019
Last Update Date	:	05/19/2022

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