Provider Demographics
NPI:1629562780
Name:MEKHURI, JAISHREE
Entity Type:Individual
Prefix:
First Name:JAISHREE
Middle Name:
Last Name:MEKHURI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14243 123RD AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14243 123 AVE
Practice Address - Street 2:
Practice Address - City:JAMIACA
Practice Address - State:NY
Practice Address - Zip Code:11436
Practice Address - Country:US
Practice Address - Phone:347-444-7846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program