Provider Demographics
NPI:1033884572
Name:BASRA, SHIVANI
Entity Type:Individual
Prefix:
First Name:SHIVANI
Middle Name:
Last Name:BASRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 184TH PL
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2417
Mailing Address - Country:US
Mailing Address - Phone:347-748-3010
Mailing Address - Fax:
Practice Address - Street 1:9040 184TH PL
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2417
Practice Address - Country:US
Practice Address - Phone:347-748-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician