Provider Demographics
NPI:1407260748
Name:PASHA, KELLI DENISE (RN)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:DENISE
Last Name:PASHA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 JAMIE ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-1118
Mailing Address - Country:US
Mailing Address - Phone:631-650-1112
Mailing Address - Fax:
Practice Address - Street 1:127 JAMIE ST
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-1118
Practice Address - Country:US
Practice Address - Phone:631-650-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-15
Last Update Date:2014-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY554608-1163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine