Provider Demographics
NPI:1457886160
Name:CAVANNA, HANIFA M (RN)
Entity Type:Individual
Prefix:MRS
First Name:HANIFA
Middle Name:M
Last Name:CAVANNA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:HANIFA
Other - Middle Name:M
Other - Last Name:SEEDAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:200 N END AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10282-1286
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 N END AVE APT 12D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10282
Practice Address - Country:US
Practice Address - Phone:585-545-0693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402252-1363LP0808X
NY728762163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health