Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 383186 | NY |
NPI | 1003492042 |
---|---|
Provider Name | Ms. Roshni Shah |
First Address | Elmhurst, NY 11373-5322 |
Second Address | Elmhurst, NY 11373-5322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2021 |
Last Update Date | 21/03/2021 |