Provider Demographics
NPI:1245647742
Name:SUBBA, SHRADHA (R N)
Entity type:Individual
Prefix:
First Name:SHRADHA
Middle Name:
Last Name:SUBBA
Suffix:
Gender:F
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8520 63RD DR FL 2
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4824
Mailing Address - Country:US
Mailing Address - Phone:347-345-7738
Mailing Address - Fax:
Practice Address - Street 1:8520 63RD DR FL 2
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4824
Practice Address - Country:US
Practice Address - Phone:347-345-7738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY686846163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse