Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Theresa Lynne Fazzolari, PA

Individual provider Physician Assistant · NPI 1659628717

Theresa Lynne Fazzolari, PA is a Physician Assistant in Brooklyn, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2012
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

150 55th St
Brooklyn, NY 11220-2508
Phone: (718) 630-7000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 004688 (NY)

Record details

NPI number1659628717
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorYes
NPI enumeratedAugust 8, 2012
Last updated in NPPESAugust 8, 2012

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