Provider Demographics
NPI:1336733948
Name:DEEPTI, FNU
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:DEEPTI
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 1:689 PRISCILLA PL
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1156
Mailing Address - Country:US
Mailing Address - Phone:929-268-5336
Mailing Address - Fax:
Practice Address - Street 1:689 PRISCILLA PL
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1156
Practice Address - Country:US
Practice Address - Phone:929-268-5336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY784972163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse