MEDICARE: SURAFAIL M AMBAYE FNP-C

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
1	363LF0000X	Family Nurse Practitioner	RN316231	GA

General Provider Information

NPI Number	:	1912882796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SURAFAIL M AMBAYE FNP-C

Provider Business Mailing Address
First Line	:	16206 SKYLINE LN NE # 16206
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-7916
Country	:	US
Telephone Number	:	206-483-9468
Fax Number	:

Provider Business Practice Location Address
First Line	:	16206 SKYLINE LN NE # 16206
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-7916
Country	:	US
Telephone Number	:	206-483-9468
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2025
Last Update Date	:	08/09/2025

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