Provider Demographics
NPI:1538774195
Name:FADIS, NATALIE ANGELIQUE (NP)
Entity type:Individual
Prefix:MISS
First Name:NATALIE
Middle Name:ANGELIQUE
Last Name:FADIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3069 42ND ST APT 3
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3054
Mailing Address - Country:US
Mailing Address - Phone:917-344-9758
Mailing Address - Fax:
Practice Address - Street 1:3069 42ND ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3054
Practice Address - Country:US
Practice Address - Phone:917-344-9758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309856363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health