Provider Demographics
NPI:1356788830
Name:KHANAL, SHUVA K (RN)
Entity type:Individual
Prefix:
First Name:SHUVA
Middle Name:K
Last Name:KHANAL
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 1:9419 66TH AVE
Mailing Address - Street 2:APT 1B
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4653
Mailing Address - Country:US
Mailing Address - Phone:347-445-9509
Mailing Address - Fax:
Practice Address - Street 1:9419 66TH AVE
Practice Address - Street 2:APT 1B
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4653
Practice Address - Country:US
Practice Address - Phone:347-445-9509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY627952-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse