Healthcare Provider Details

I. General information

NPI: 1114736147
Provider Name (Legal Business Name): SHARIFA MUSTAFOEVA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 08/30/2025
Certification Date: 08/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BARNUM AVE
PLAINVIEW NY
11803-5234
US

IV. Provider business mailing address

64 BARNUM AVE
PLAINVIEW NY
11803-5234
US

V. Phone/Fax

Practice location:
  • Phone: 347-806-1857
  • Fax:
Mailing address:
  • Phone: 347-806-1857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF354334-01
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: