Healthcare Provider Details

I. General information

NPI: 1427402304
Provider Name (Legal Business Name): FANEEZA AMEERALLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13030 180 STREET
SPRINGFIELD GARDENS NY
11434
US

IV. Provider business mailing address

12011 109TH AVE APT D1
SOUTH OZONE PARK NY
11420
US

V. Phone/Fax

Practice location:
  • Phone: 718-527-2200
  • Fax: 718-527-3707
Mailing address:
  • Phone: 718-219-0074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: