Provider Demographics
NPI:1346884673
Name:ST FLEUR, MARILISA (FNP)
Entity Type:Individual
Prefix:
First Name:MARILISA
Middle Name:
Last Name:ST FLEUR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARILISA
Other - Middle Name:
Other - Last Name:ST. FLEUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:6 COBBLESTONE CT
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2301
Mailing Address - Country:US
Mailing Address - Phone:845-548-9692
Mailing Address - Fax:
Practice Address - Street 1:800 CROSS RIVER RD
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-3549
Practice Address - Country:US
Practice Address - Phone:914-763-8151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine