Provider Demographics
NPI:1396213872
Name:MISHRA, SHRUTI PAVANKUMAR (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:SHRUTI
Middle Name:PAVANKUMAR
Last Name:MISHRA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3315 84TH ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1552
Mailing Address - Country:US
Mailing Address - Phone:848-242-5211
Mailing Address - Fax:
Practice Address - Street 1:3027 30TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2261
Practice Address - Country:US
Practice Address - Phone:718-777-2244
Practice Address - Fax:718-777-2254
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041624-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist