Provider Demographics
NPI:1033666904
Name:BASHIC, INDIRA (NP)
Entity Type:Individual
Prefix:MRS
First Name:INDIRA
Middle Name:
Last Name:BASHIC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4247 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6220
Mailing Address - Country:US
Mailing Address - Phone:718-605-4000
Mailing Address - Fax:718-605-4040
Practice Address - Street 1:4247 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6220
Practice Address - Country:US
Practice Address - Phone:718-605-4000
Practice Address - Fax:718-605-4040
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307607-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily