Healthcare Provider Details

I. General information

NPI: 1013862440
Provider Name (Legal Business Name): FARAH GAZIZ DIMSUYU PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 GAFFNEY ST
GLEN COVE NY
11542-4240
US

IV. Provider business mailing address

16 GAFFNEY ST
GLEN COVE NY
11542-4240
US

V. Phone/Fax

Practice location:
  • Phone: 516-404-3094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF407958
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: