Provider Demographics
NPI:1801609219
Name:MOHAN, ANJALI EESHA
Entity type:Individual
Prefix:
First Name:ANJALI
Middle Name:EESHA
Last Name:MOHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2962 TRINITY ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3224
Mailing Address - Country:US
Mailing Address - Phone:516-543-8480
Mailing Address - Fax:
Practice Address - Street 1:2962 TRINITY ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-3224
Practice Address - Country:US
Practice Address - Phone:516-543-8480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant