Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 348169 | NY |
NPI | 1003582156 |
---|---|
Provider Name | Cindy Queliza |
First Address | Floral Park, NY 11004-1046 |
Second Address | Great Neck, NY 11021-5301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2021 |
Last Update Date | 18/08/2021 |