Healthcare Provider Details

I. General information

NPI: 1871336974
Provider Name (Legal Business Name): FIFA ATEF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FIFAA ATEF

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 HOLSMAN RD
STATEN ISLAND NY
10301-4426
US

IV. Provider business mailing address

37 HOLSMAN RD
STATEN ISLAND NY
10301-4426
US

V. Phone/Fax

Practice location:
  • Phone: 929-867-2287
  • Fax:
Mailing address:
  • Phone: 929-867-2287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: