Provider Demographics
NPI:1467029207
Name:MAHENGA, RAVAI P (RN)
Entity type:Individual
Prefix:
First Name:RAVAI
Middle Name:P
Last Name:MAHENGA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 BROOKHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4406
Mailing Address - Country:US
Mailing Address - Phone:718-869-8000
Mailing Address - Fax:
Practice Address - Street 1:1711 BROOKHAVEN AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4406
Practice Address - Country:US
Practice Address - Phone:718-869-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY741771163WG0000X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice