Provider Demographics
NPI:1114209954
Name:SEWNARINE, KIMBERLY EVA (PA)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:EVA
Last Name:SEWNARINE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6465
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-0465
Mailing Address - Country:US
Mailing Address - Phone:718-578-8578
Mailing Address - Fax:
Practice Address - Street 1:3451 9TH ST
Practice Address - Street 2:1B
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-5161
Practice Address - Country:US
Practice Address - Phone:718-578-8578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015062363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant