Provider Demographics
NPI:1194369686
Name:CHISHTY, MISHA
Entity Type:Individual
Prefix:
First Name:MISHA
Middle Name:
Last Name:CHISHTY
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 1:2213 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3151
Mailing Address - Country:US
Mailing Address - Phone:832-640-2889
Mailing Address - Fax:
Practice Address - Street 1:2213 26TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-3151
Practice Address - Country:US
Practice Address - Phone:832-640-2889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant