=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366210908
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SY FAMILY HEALTH NP PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2023
-----------------------------------------------------
Last Update Date | 02/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14421 72ND RD
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11367-2405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-727-6638
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14421 72ND RD
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11367-2405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-559-6699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | STELLA YUNAYEVA
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 646-559-6699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------