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Individual

DEANNA KHAVASOVA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
71-20 110TH ST, FOREST HILLS, NY 11375
(718) 793-3200
Mailing address
102-41 63RD ROAD, FOREST HILLS, NY 11375
(954) 554-3783

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F310862-01
NY

Other

Enumeration date
06/26/2023
Last updated
06/26/2023
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