Provider Demographics
NPI:1831734136
Name:ASAMOAH, EVA (FNP)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:ASAMOAH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 BERKELEY AVE
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-1903
Mailing Address - Country:US
Mailing Address - Phone:631-459-0693
Mailing Address - Fax:
Practice Address - Street 1:1787 MIDDLE COUNTRY RD # B
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-3507
Practice Address - Country:US
Practice Address - Phone:631-320-3053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-10
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345213-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily