Healthcare Provider Details

I. General information

NPI: 1417861360
Provider Name (Legal Business Name): STACY ZACHARIAH SEBASTIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 3RD AVE
BROOKLYN NY
11220-3702
US

IV. Provider business mailing address

7344 AUSTIN ST APT 2N
FOREST HILLS NY
11375-6223
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-7000
  • Fax:
Mailing address:
  • Phone: 347-426-6855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number313061
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: