Healthcare Provider Details

I. General information

NPI: 1295492833
Provider Name (Legal Business Name): AGYEIBEA APAU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 FOREST AVE
STATEN ISLAND NY
10303-1506
US

IV. Provider business mailing address

715 PORT RICHMOND AVE
STATEN ISLAND NY
10302-1736
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-0200
  • Fax:
Mailing address:
  • Phone: 347-204-2769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF345610
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: