Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 10915 | NC |
N | 1223G0001X | General Practice | 10915 | NC |
N | 213EG0000X | General Practice | 10915 | NC |
NPI | 1700319035 |
---|---|
Provider Name | Kaaenaat Mustafa |
First Address | Bronx, NY 10453 |
Second Address | Cary, NC 27519-2908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2017 |
Last Update Date | 03/10/2019 |