Individual
SHANTHI VENKATACHALAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
1400 WANTAGH AVE, WANTAGH, NY 11793-2257
(631) 327-4868
Mailing address
8104 248TH ST, BELLEROSE, NY 11426-1719
(631) 374-4308
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
488472
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F406029
NY
Other
Enumeration date
05/14/2018
Last updated
08/18/2025
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