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NPI Code Detail

MEDICARE: MS. FABIOLA DORESTANT NP

MEDICARE: MS. FABIOLA DORESTANT NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse767903NY
2363LW0102XWomen's Health Nurse Practitioner421910NY

General Provider Information

NPI Number : 1154266807
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. FABIOLA DORESTANT NP
Provider Business Mailing Address
First Line : 1859 E 52ND ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-4616
Country : US
Telephone Number : 347-907-1220
Fax Number :
Provider Business Practice Location Address
First Line : 445 LENOX RD
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2017
Country : US
Telephone Number : 718-270-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2026
Last Update Date : 04/20/2026

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