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General NPI Number Information
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NPI Number | 1740842731
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Entity Type | Individual
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Provider Name | MAIRA NUSRAT
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Gender | Female
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 101 NICOLLS RD
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City | STONY BROOK
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State | NY
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Zip | 11794-3656
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Country | US
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Telephone | 631-444-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 101 NICOLLS RD STE 20
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City | STONY BROOK
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State | NY
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Zip | 11794-0001
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Country | US
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Telephone | 631-444-5437
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | 318415
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License Number State | NY
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