Provider Demographics
NPI:1477965606
Name:FAZILI, RAFIQA
Entity Type:Individual
Prefix:
First Name:RAFIQA
Middle Name:
Last Name:FAZILI
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 1:1 SYLVAN PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 SYLVAN PKWY
Practice Address - Street 2:
Practice Address - City:WEST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-1134
Practice Address - Country:US
Practice Address - Phone:716-568-5248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128548-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist