Provider Demographics
NPI:1275219685
Name:FELIZ-ALI, DAMARIS EVANGELINA
Entity Type:Individual
Prefix:
First Name:DAMARIS
Middle Name:EVANGELINA
Last Name:FELIZ-ALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1258
Mailing Address - Country:US
Mailing Address - Phone:516-817-1771
Mailing Address - Fax:
Practice Address - Street 1:270 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1224
Practice Address - Country:US
Practice Address - Phone:516-817-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty