Healthcare Provider Details

I. General information

NPI: 1235712878
Provider Name (Legal Business Name): OLIVIA SARA DEUTSCH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2021
Last Update Date: 05/02/2021
Certification Date: 05/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 COLONY ST
WEST HEMPSTEAD NY
11552-2427
US

IV. Provider business mailing address

268 COLONY ST
WEST HEMPSTEAD NY
11552-2427
US

V. Phone/Fax

Practice location:
  • Phone: 516-639-5298
  • Fax:
Mailing address:
  • Phone: 516-639-5298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number345771
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: