MEDICARE: JASHA BASILA RN

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	956064	NY

General Provider Information

NPI Number	:	1689533093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASHA BASILA RN

Provider Business Mailing Address
First Line	:	5157 GORSLINE ST APT 1F
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-4142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5157 GORSLINE ST APT 1F
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-4142
Country	:	US
Telephone Number	:	917-513-1076
Fax Number	:

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

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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