Provider Demographics
NPI:1396960761
Name:KANZAVELI, NANA (PA)
Entity type:Individual
Prefix:MISS
First Name:NANA
Middle Name:
Last Name:KANZAVELI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2797 OCEAN PARKWAY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7868
Mailing Address - Country:US
Mailing Address - Phone:718-615-4000
Mailing Address - Fax:718-615-4004
Practice Address - Street 1:2797 OCEAN PARKWAY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7868
Practice Address - Country:US
Practice Address - Phone:718-615-4000
Practice Address - Fax:718-615-4004
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02759699Medicaid
NY02759699Medicaid