Healthcare Provider Details

I. General information

NPI: 1710806096
Provider Name (Legal Business Name): FAVOUR MADUMERE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

IV. Provider business mailing address

719 E 213TH ST APT 3A
BRONX NY
10467-5964
US

V. Phone/Fax

Practice location:
  • Phone: 646-520-9654
  • Fax:
Mailing address:
  • Phone: 646-520-9654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number914488
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number914488
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number914488
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: