Provider Demographics
NPI:1083013197
Name:FUZAYLOVA, LYUDMILA (FNP)
Entity Type:Individual
Prefix:
First Name:LYUDMILA
Middle Name:
Last Name:FUZAYLOVA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10525 65TH AVE APT 4H
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1802
Mailing Address - Country:US
Mailing Address - Phone:646-704-3705
Mailing Address - Fax:
Practice Address - Street 1:7224 KISSENA BLVD STE 1H
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2716
Practice Address - Country:US
Practice Address - Phone:718-576-4652
Practice Address - Fax:718-576-4652
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337547-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily