Healthcare Provider Details

I. General information

NPI: 1134050883
Provider Name (Legal Business Name): DAVID SEZANAYEV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9809 65TH RD APT 2C
REGO PARK NY
11374-3503
US

IV. Provider business mailing address

9809 65TH RD APT 2C
REGO PARK NY
11374-3503
US

V. Phone/Fax

Practice location:
  • Phone: 646-206-1982
  • Fax:
Mailing address:
  • Phone: 646-206-1982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number359818
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: