Provider Demographics
NPI:1780308353
Name:JHAVERI, ATIKSHA (APN)
Entity type:Individual
Prefix:
First Name:ATIKSHA
Middle Name:
Last Name:JHAVERI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 OAK DR
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3337
Mailing Address - Country:US
Mailing Address - Phone:551-580-3268
Mailing Address - Fax:
Practice Address - Street 1:2701 QUEENS PLZ N FL 10
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4022
Practice Address - Country:US
Practice Address - Phone:551-580-3268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01160700363LA2200X
NYF310739-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health