Healthcare Provider Details

I. General information

NPI: 1164679130
Provider Name (Legal Business Name): CAROLYN SEFERSHAYAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1477 HYLAN BLVD
STATEN ISLAND NY
10305-1906
US

IV. Provider business mailing address

128 SEIDMAN AVE
STATEN ISLAND NY
10312-5528
US

V. Phone/Fax

Practice location:
  • Phone: 718-979-6900
  • Fax:
Mailing address:
  • Phone: 718-948-5534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number384906
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: