Provider Demographics
NPI:1316607435
Name:SHATHI, NAFISA N (MHCLP)
Entity type:Individual
Prefix:
First Name:NAFISA
Middle Name:N
Last Name:SHATHI
Suffix:
Gender:F
Credentials:MHCLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9006 242ND ST
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-1135
Mailing Address - Country:US
Mailing Address - Phone:347-822-6336
Mailing Address - Fax:
Practice Address - Street 1:17 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5701
Practice Address - Country:US
Practice Address - Phone:516-459-2920
Practice Address - Fax:516-285-1616
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP107891101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP107891OtherMENTAL HEALTH COUNSELOR