Provider Demographics
NPI:1851869630
Name:RAFAILOVA-SLIOZBERG, ELIZABETT (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETT
Middle Name:
Last Name:RAFAILOVA-SLIOZBERG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5552
Mailing Address - Country:US
Mailing Address - Phone:215-860-0775
Mailing Address - Fax:215-860-7754
Practice Address - Street 1:777 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5552
Practice Address - Country:US
Practice Address - Phone:215-860-0775
Practice Address - Fax:215-860-7754
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019471363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP019471OtherNP