Provider Demographics
NPI:1457902058
Name:DEY, SHUBRATA (FNP)
Entity Type:Individual
Prefix:
First Name:SHUBRATA
Middle Name:
Last Name:DEY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16410 NORTHERN BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2668
Mailing Address - Country:US
Mailing Address - Phone:718-886-2011
Mailing Address - Fax:929-333-7950
Practice Address - Street 1:16410 NORTHERN BLVD STE 204
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2668
Practice Address - Country:US
Practice Address - Phone:718-886-2011
Practice Address - Fax:929-333-7950
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004216363LF0000X
NY349573363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily