Provider Demographics
NPI:1770347213
Name:TALASAZAN, SARAH TOOBA (FNP-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:TOOBA
Last Name:TALASAZAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ROYAL CT UNIT 1105
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2618
Mailing Address - Country:US
Mailing Address - Phone:516-592-9277
Mailing Address - Fax:
Practice Address - Street 1:1000 ROYAL CT UNIT 1105
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2618
Practice Address - Country:US
Practice Address - Phone:516-592-9277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY773913163W00000X
NY353296364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse