Provider Demographics
NPI:1962129981
Name:SEERATTAN, ELIZABETH ELLIE (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ELLIE
Last Name:SEERATTAN
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 1:11103 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2306
Mailing Address - Country:US
Mailing Address - Phone:347-361-8781
Mailing Address - Fax:
Practice Address - Street 1:11103 91ST AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2306
Practice Address - Country:US
Practice Address - Phone:718-849-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF349321-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily