Healthcare Provider Details

I. General information

NPI: 1811809049
Provider Name (Legal Business Name): SABINA YOUSUPOV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7347 182ND ST
FRESH MEADOWS NY
11366-1611
US

IV. Provider business mailing address

7347 182ND ST
FRESH MEADOWS NY
11366-1611
US

V. Phone/Fax

Practice location:
  • Phone: 347-337-3982
  • Fax:
Mailing address:
  • Phone: 347-337-3982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF360914-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: