Provider Demographics
NPI:1376226506
Name:QURASHI, PROVA HUMAIRA (PA-C)
Entity Type:Individual
Prefix:
First Name:PROVA
Middle Name:HUMAIRA
Last Name:QURASHI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 POST AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2201
Mailing Address - Country:US
Mailing Address - Phone:516-333-1444
Mailing Address - Fax:516-333-2725
Practice Address - Street 1:8212 151ST AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1793
Practice Address - Country:US
Practice Address - Phone:718-843-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030334363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant