Individual
FADWA MINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
450 CLARKSON AVE # 67, BROOKLYN, NY 11203-2012
(718) 270-1000
Mailing address
263 FARMINGTON AVE, FARMINGTON, CT 06030-1921
(860) 679-2147
(860) 679-4624
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
11/07/2022
Last updated
07/30/2024
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