MEDICARE: MS. TEHRAN HARRISON

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	163W00000X	Registered Nurse	656502	NY
2	363LF0000X	Family Nurse Practitioner	348537	NY

General Provider Information

NPI Number	:	1568711547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TEHRAN HARRISON

Provider Business Mailing Address
First Line	:	PO BOX 1627
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11582-1627
Country	:	US
Telephone Number	:	516-949-1910
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 ASH ST
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-4811
Country	:	US
Telephone Number	:	516-949-1910
Fax Number	:

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

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	10/06/2022

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