Provider Demographics
NPI:1902612369
Name:MINAFO, JULIA NICOLE
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:NICOLE
Last Name:MINAFO
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 1:3886 KINGSBERRY RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1018
Mailing Address - Country:US
Mailing Address - Phone:516-297-8197
Mailing Address - Fax:
Practice Address - Street 1:1000 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11549-0001
Practice Address - Country:US
Practice Address - Phone:516-463-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program