Healthcare Provider Details

I. General information

NPI: 1073003950
Provider Name (Legal Business Name): RACHEL OLMEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 CROOKED HILL RD
BRENTWOOD NY
11717-1019
US

IV. Provider business mailing address

235 LOEFFLER ST
BRENTWOOD NY
11717-5011
US

V. Phone/Fax

Practice location:
  • Phone: 631-761-4723
  • Fax:
Mailing address:
  • Phone: 631-436-5607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number596138
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: