Provider Demographics
NPI:1184390890
Name:FUZAILOV, SARAH SHELLEY
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:SHELLEY
Last Name:FUZAILOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14412 70TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1718
Mailing Address - Country:US
Mailing Address - Phone:929-401-7445
Mailing Address - Fax:
Practice Address - Street 1:8403 CUTHBERT RD
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2140
Practice Address - Country:US
Practice Address - Phone:347-454-9082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-22
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY824589163W00000X
NY353454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse