Healthcare Provider Details

I. General information

NPI: 1649135716
Provider Name (Legal Business Name): RONALD WAYNE RENSHTIE PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 BROADWAY STE R
ALBANY NY
12207-2922
US

IV. Provider business mailing address

PO BOX 485
WALLKILL NY
12589-0485
US

V. Phone/Fax

Practice location:
  • Phone: 845-243-1300
  • Fax:
Mailing address:
  • Phone: 845-243-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407657
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: