Healthcare Provider Details

I. General information

NPI: 1679532352
Provider Name (Legal Business Name): MARISSA LINDA-KAYE PERSAUD NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMUNITY DR 5 MONTI
MANHASSET NY
11030-3816
US

IV. Provider business mailing address

1120 CONCORD ST
FRANKLIN SQUARE NY
11010-2721
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-4330
  • Fax:
Mailing address:
  • Phone: 516-775-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303609-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: