MEDICARE: RAISA PRIYEVA FNP

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	F336844-1	NY

General Provider Information

NPI Number	:	1962784876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAISA PRIYEVA FNP

Provider Business Mailing Address
First Line	:	64-11 99 ST APT 308
Second Line	:
City	:	USA
State	:	NY
Zip	:	11374
Country	:	US
Telephone Number	:	347-431-6726
Fax Number	:

Provider Business Practice Location Address
First Line	:	690 BAY ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-3830
Country	:	US
Telephone Number	:	718-816-1020
Fax Number	:

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

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	09/16/2011

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