Healthcare Provider Details

I. General information

NPI: 1881514818
Provider Name (Legal Business Name): PERPETUAL TETTEH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 HICKS ST
BRONX NY
10469-1708
US

IV. Provider business mailing address

1429 HICKS ST
BRONX NY
10469-1708
US

V. Phone/Fax

Practice location:
  • Phone: 917-362-3813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN17049
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: