Provider Demographics
NPI:1508532581
Name:PLISHTIYEVA, KHEVSI (NP)
Entity Type:Individual
Prefix:
First Name:KHEVSI
Middle Name:
Last Name:PLISHTIYEVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7503 192ND ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1859
Mailing Address - Country:US
Mailing Address - Phone:347-571-3963
Mailing Address - Fax:
Practice Address - Street 1:10255 63RD RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1048
Practice Address - Country:US
Practice Address - Phone:347-201-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF353473-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily