Provider Demographics
NPI:1912547654
Name:BURRAFATO, BIANCA LIN (MSED)
Entity Type:Individual
Prefix:MISS
First Name:BIANCA
Middle Name:LIN
Last Name:BURRAFATO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 SLEIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-1942
Mailing Address - Country:US
Mailing Address - Phone:646-662-0446
Mailing Address - Fax:
Practice Address - Street 1:447 SLEIGHT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10307-1942
Practice Address - Country:US
Practice Address - Phone:646-662-0446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
17OtherOTHER SERVICE PROVIDER