Healthcare Provider Details

I. General information

NPI: 1902612369
Provider Name (Legal Business Name): JULIA NICOLE MINAFO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HEMPSTEAD TPKE
HEMPSTEAD NY
11549-0001
US

IV. Provider business mailing address

3886 KINGSBERRY RD
SEAFORD NY
11783-1018
US

V. Phone/Fax

Practice location:
  • Phone: 516-463-6600
  • Fax:
Mailing address:
  • Phone: 516-297-8197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number033446
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: