Provider Demographics
NPI:1285903104
Name:MOHAN, SYAMALA (RN)
Entity type:Individual
Prefix:MRS
First Name:SYAMALA
Middle Name:
Last Name:MOHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:SYAMALAKUMARI
Other - Middle Name:
Other - Last Name:KUTTAPPANNAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:423-47 STREET
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757
Mailing Address - Country:US
Mailing Address - Phone:631-412-3058
Mailing Address - Fax:631-412-3058
Practice Address - Street 1:423 -47 ST.
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-1928
Practice Address - Country:US
Practice Address - Phone:631-412-3058
Practice Address - Fax:631-412-3058
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY505124-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse