Healthcare Provider Details

I. General information

NPI: 1396960761
Provider Name (Legal Business Name): NANA KANZAVELI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2797 OCEAN PARKWAY 3RD FLOOR
BROOKLYN NY
11235-7868
US

IV. Provider business mailing address

2797 OCEAN PARKWAY 3RD FLOOR
BROOKLYN NY
11235-7868
US

V. Phone/Fax

Practice location:
  • Phone: 718-615-4000
  • Fax: 718-615-4004
Mailing address:
  • Phone: 718-615-4000
  • Fax: 718-615-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: