Basic Information
| Provider Information | |||||||||
| NPI: | 1194381020 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THARAKAN | ||||||||
| FirstName: | SHELBY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 THE DELL | ||||||||
| Address2: | |||||||||
| City: | ALBERTSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115071014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162702721 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11912 94TH AVE FL 1 | ||||||||
| Address2: | |||||||||
| City: | SOUTH RICHMOND HILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114191332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182970440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2019 | ||||||||
| LastUpdateDate: | 02/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 344111 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | F344111-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.