Provider Demographics
NPI:1831857416
Name:ALI, SYEDA SAMENA (NP)
Entity type:Individual
Prefix:
First Name:SYEDA
Middle Name:SAMENA
Last Name:ALI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SAMENA
Other - Middle Name:
Other - Last Name:ALI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2316 BROADWAY
Mailing Address - Street 2:APT 1R
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4154
Mailing Address - Country:US
Mailing Address - Phone:732-585-3335
Mailing Address - Fax:
Practice Address - Street 1:2316 BROADWAY
Practice Address - Street 2:APT 1R
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-4154
Practice Address - Country:US
Practice Address - Phone:732-585-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310571363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty