MEDICARE: MICHAEL WHITLEY PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	405634	NY

General Provider Information

NPI Number	:	1528606266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WHITLEY PMHNP-BC

Provider Business Mailing Address
First Line	:	2248 BROADWAY # 1243
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-5805
Country	:	US
Telephone Number	:	347-201-6815
Fax Number	:	725-567-4149

Provider Business Practice Location Address
First Line	:	2248 BROADWAY # 1243
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-5805
Country	:	US
Telephone Number	:	347-201-6815
Fax Number	:	725-567-4149

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2019
Last Update Date	:	04/26/2025

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