Provider Demographics
NPI:1235649922
Name:AFZAL, TANISHA SHANTE (LPN)
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:SHANTE
Last Name:AFZAL
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 1:52 N KENSINGTON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5004
Mailing Address - Country:US
Mailing Address - Phone:646-525-0348
Mailing Address - Fax:
Practice Address - Street 1:52 N KENSINGTON AVE APT 1
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5004
Practice Address - Country:US
Practice Address - Phone:646-525-0348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-07
Last Update Date:2017-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327679164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse