Provider Demographics
NPI:1699592253
Name:SURHATI, FATIMA
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:SURHATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601A SURF AVE APT 21C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3401
Mailing Address - Country:US
Mailing Address - Phone:917-886-8548
Mailing Address - Fax:
Practice Address - Street 1:601A SURF AVE APT 21C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-3401
Practice Address - Country:US
Practice Address - Phone:917-886-8548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF355165-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily