Provider Demographics
NPI:1336399146
Name:MEHTA, SIMERAN KAUR (LPN)
Entity Type:Individual
Prefix:
First Name:SIMERAN
Middle Name:KAUR
Last Name:MEHTA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SEEMA
Other - Middle Name:KAUR
Other - Last Name:MEHTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:950 S OYSTER BAY RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3510
Mailing Address - Country:US
Mailing Address - Phone:516-348-0285
Mailing Address - Fax:516-348-0288
Practice Address - Street 1:950 S OYSTER BAY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3510
Practice Address - Country:US
Practice Address - Phone:516-348-0285
Practice Address - Fax:516-348-0288
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287403-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse