Provider Demographics
NPI:1649734245
Name:ASHUROVA, ELLA (AGNP)
Entity Type:Individual
Prefix:MRS
First Name:ELLA
Middle Name:
Last Name:ASHUROVA
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2872 86TH ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4666
Mailing Address - Country:US
Mailing Address - Phone:718-873-6171
Mailing Address - Fax:
Practice Address - Street 1:150 EILEEN WAY UNIT 1
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-5313
Practice Address - Country:US
Practice Address - Phone:516-855-5255
Practice Address - Fax:516-921-2451
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308503363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health