Provider Demographics
NPI:1982136990
Name:WATKINS, ATSEI
Entity Type:Individual
Prefix:MS
First Name:ATSEI
Middle Name:
Last Name:WATKINS
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 1:565 AVENUE A
Mailing Address - Street 2:UNIT 205
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3200
Mailing Address - Country:US
Mailing Address - Phone:516-710-3430
Mailing Address - Fax:
Practice Address - Street 1:565 AVENUE A
Practice Address - Street 2:UNIT 205
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3200
Practice Address - Country:US
Practice Address - Phone:516-710-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY719425174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth Educator
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty