Healthcare Provider Details

I. General information

NPI: 1093637605
Provider Name (Legal Business Name): ZAKIYA VALERIE EATON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 HARRISON AVE
STATEN ISLAND NY
10302-1102
US

IV. Provider business mailing address

158 HARRISON AVE
STATEN ISLAND NY
10302-1102
US

V. Phone/Fax

Practice location:
  • Phone: 646-581-8799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number351807
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: