Healthcare Provider Details

I. General information

NPI: 1306767082
Provider Name (Legal Business Name): ADEL AVEZOFF FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

6155 99TH ST APT 4H
REGO PARK NY
11374
US

IV. Provider business mailing address

6155 99TH ST APT 4H
REGO PARK NY
11374
US

V. Phone/Fax

Practice location:
  • Phone: 347-419-6580
  • Fax:
Mailing address:
  • Phone: 347-419-6580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF359931-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: