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General NPI Number Information
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NPI Number | 1114704285
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Entity Type | Organization
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Legal Business Name | NOVA FAMILY HEALTH NP, PC
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 1400 WANTAGH AVE
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City | WANTAGH
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State | NY
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Zip | 11793-2257
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Country | US
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Telephone | 516-308-7405
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Fax | 516-308-7404
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Provider Business Mailing Address
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Address Line | 32 COLUMBIA ST
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City | FARMINGDALE
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State | NY
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Zip | 11735-2606
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. VALESSA MESIDOR
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Credential | FNP
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Telephone | 516-587-4541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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