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Individual

FAIRY LAINE ESPINA MANZANO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
20 EXETER AVE, LYNBROOK, NY 11563-3710
(347) 351-2454
Mailing address
600 E 125TH ST, NEW YORK, NY 10035-6000
(646) 766-4000

Taxonomy

Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
730040
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
406726
NY

Other

Enumeration date
06/09/2020
Last updated
04/13/2025
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