Provider Demographics
NPI:1568013795
Name:BEATUS, ELLIE SLIVKO (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELLIE
Middle Name:SLIVKO
Last Name:BEATUS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:ELISHEVA
Other - Middle Name:SLIVKO
Other - Last Name:BEATUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:109 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2401
Mailing Address - Country:US
Mailing Address - Phone:516-472-0021
Mailing Address - Fax:
Practice Address - Street 1:865 NORTHERN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5310
Practice Address - Country:US
Practice Address - Phone:516-622-5062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-29
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344807-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily