Provider Demographics
NPI:1700445020
Name:CHOWDHURY, TAZNEEN ITTAKA (NP)
Entity Type:Individual
Prefix:
First Name:TAZNEEN
Middle Name:ITTAKA
Last Name:CHOWDHURY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2976 NORTHERN BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-2829
Mailing Address - Country:US
Mailing Address - Phone:862-264-7291
Mailing Address - Fax:
Practice Address - Street 1:2976 NORTHERN BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2829
Practice Address - Country:US
Practice Address - Phone:862-264-7291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402538-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health