Provider Demographics
NPI:1093502627
Name:MUNAZZAH, FNU
Entity type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:MUNAZZAH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WILDBERRY CT
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-6254
Mailing Address - Country:US
Mailing Address - Phone:518-901-8062
Mailing Address - Fax:
Practice Address - Street 1:8 WILDBERRY CT
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-6254
Practice Address - Country:US
Practice Address - Phone:518-901-8062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program