Provider Demographics
NPI:1083286736
Name:DEODHARRY, SAVETRY (LPN)
Entity Type:Individual
Prefix:
First Name:SAVETRY
Middle Name:
Last Name:DEODHARRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9125 217TH ST # 1
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1238
Mailing Address - Country:US
Mailing Address - Phone:917-634-1997
Mailing Address - Fax:
Practice Address - Street 1:1711 BROOKHAVEN AVENUE
Practice Address - Street 2:FAR ROCKAWAY
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-869-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317663-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse