Healthcare Provider Details

I. General information

NPI: 1538964986
Provider Name (Legal Business Name): DAJANA NAZARKO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 NEW SCOTLAND RD STE 203
SLINGERLANDS NY
12159-9386
US

IV. Provider business mailing address

8 FAIRWAY LN
SCHENECTADY NY
12304-2536
US

V. Phone/Fax

Practice location:
  • Phone: 518-439-2273
  • Fax:
Mailing address:
  • Phone: 518-424-5831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number383710
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: