Provider Demographics
NPI:1366878613
Name:BAKSH, SANTHUSIA MONIQUE
Entity type:Individual
Prefix:MRS
First Name:SANTHUSIA
Middle Name:MONIQUE
Last Name:BAKSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20020 15TH RD FL 2
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1036
Mailing Address - Country:US
Mailing Address - Phone:347-970-1097
Mailing Address - Fax:
Practice Address - Street 1:20020 15TH RD FL 2HD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1036
Practice Address - Country:US
Practice Address - Phone:347-970-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31328-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSM45475FMedicaid