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General NPI Number Information
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NPI Number | 1497573760
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Entity Type | Organization
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Legal Business Name | AVENUE S NP IN FAMILY HEALTH PC
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Dates
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Enumeration Date | 09/26/2024
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 3364 NOSTRAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11229-4004
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Country | US
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Telephone | 347-651-9939
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 RIVERTON ST
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902-2256
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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 | SHAHZODA YULDASHEVA
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Credential | NP
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Telephone | 347-651-9939
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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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