Healthcare Provider Details

I. General information

NPI: 1902725294
Provider Name (Legal Business Name): MICHELLE SUYUNOVA FNP BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1752 FRANCIS LEWIS BLVD
WHITESTONE NY
11357-3247
US

IV. Provider business mailing address

8052 190TH ST
HOLLIS NY
11423-1039
US

V. Phone/Fax

Practice location:
  • Phone: 718-746-9494
  • Fax:
Mailing address:
  • Phone: 917-587-5441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number359015
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: