Provider Demographics
NPI:1568100451
Name:HARRIS, FLEURETTE ELAINE (OMD)
Entity Type:Individual
Prefix:DR
First Name:FLEURETTE
Middle Name:ELAINE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:MS
Other - First Name:FLEURETTE
Other - Middle Name:ELAINE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOM
Mailing Address - Street 1:1516 DUTCH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4521
Mailing Address - Country:US
Mailing Address - Phone:516-424-6486
Mailing Address - Fax:
Practice Address - Street 1:1516 DUTCH BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4521
Practice Address - Country:US
Practice Address - Phone:516-424-6486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-22
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty