Provider Demographics
NPI:1235941865
Name:RIVERA, NYASHA
Entity type:Individual
Prefix:
First Name:NYASHA
Middle Name:
Last Name:RIVERA
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 1:9030 METROPOLITAN AVENUE
Mailing Address - Street 2:SUITE 3/ #1017
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:347-461-7751
Mailing Address - Fax:
Practice Address - Street 1:9030 METROPOLITAN AVENUE
Practice Address - Street 2:SUITE 3/ #1017
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:347-461-7751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109317104100000X
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No104100000XBehavioral Health & Social Service ProvidersSocial Worker