Provider Demographics
NPI:1558961581
Name:PLATONOVA, ANASTASIA (FNP)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:PLATONOVA
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 1:75 OCEANA DR E APT 3H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6671
Mailing Address - Country:US
Mailing Address - Phone:347-634-4021
Mailing Address - Fax:
Practice Address - Street 1:2379 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5516
Practice Address - Country:US
Practice Address - Phone:718-942-4682
Practice Address - Fax:718-942-4683
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346791-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine