Provider Demographics
NPI:1992178792
Name:DUMAN, FAZILA
Entity Type:Individual
Prefix:MRS
First Name:FAZILA
Middle Name:
Last Name:DUMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FAZILA
Other - Middle Name:
Other - Last Name:WALYZADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:98 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2378
Mailing Address - Country:US
Mailing Address - Phone:631-355-4884
Mailing Address - Fax:
Practice Address - Street 1:98 5TH AVE
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742
Practice Address - Country:US
Practice Address - Phone:631-355-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker