Provider Demographics
NPI:1205459534
Name:JAGDEO, SHYAN INDERA (NP)
Entity type:Individual
Prefix:MS
First Name:SHYAN
Middle Name:INDERA
Last Name:JAGDEO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 ANCHOR DR
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1602
Mailing Address - Country:US
Mailing Address - Phone:718-473-5660
Mailing Address - Fax:
Practice Address - Street 1:645 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2956
Practice Address - Country:US
Practice Address - Phone:516-889-1100
Practice Address - Fax:516-889-1531
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY712437363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care