Provider Demographics
NPI:1932345865
Name:PERSAD, JENNIFER SHAKUNTALA (NP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SHAKUNTALA
Last Name:PERSAD
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:27 VERONA PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5421
Mailing Address - Country:US
Mailing Address - Phone:516-728-3601
Mailing Address - Fax:516-812-0071
Practice Address - Street 1:27 VERONA PL
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5421
Practice Address - Country:US
Practice Address - Phone:516-728-3601
Practice Address - Fax:516-812-0071
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-24
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY513619363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health