Provider Demographics
NPI:1295508661
Name:GASSMALLA, ELAF ZAKARIA
Entity type:Individual
Prefix:
First Name:ELAF
Middle Name:ZAKARIA
Last Name:GASSMALLA
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 1:170 14TH ST # 2
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-2528
Mailing Address - Country:US
Mailing Address - Phone:716-768-9191
Mailing Address - Fax:
Practice Address - Street 1:170 14TH ST # 2
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-2528
Practice Address - Country:US
Practice Address - Phone:716-768-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014053101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health