Healthcare Provider Details

I. General information

NPI: 1437834355
Provider Name (Legal Business Name): ADARA MIFSUD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3531 LONG BEACH RD
OCEANSIDE NY
11572-5700
US

IV. Provider business mailing address

3531 LONG BEACH RD
OCEANSIDE NY
11572-5700
US

V. Phone/Fax

Practice location:
  • Phone: 212-385-3700
  • Fax:
Mailing address:
  • Phone: 212-385-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: