Provider Demographics
NPI:1871286088
Name:SHANKAR, PARVATHI KUTTY (RN)
Entity type:Individual
Prefix:
First Name:PARVATHI
Middle Name:KUTTY
Last Name:SHANKAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 FULTON AVE APT 645
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4126
Mailing Address - Country:US
Mailing Address - Phone:516-434-9574
Mailing Address - Fax:
Practice Address - Street 1:451 FULTON AVE APT 645
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4126
Practice Address - Country:US
Practice Address - Phone:516-434-9574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY571749-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse