Healthcare Provider Details

I. General information

NPI: 1780204115
Provider Name (Legal Business Name): DAEVINA CHARLES MD,MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 MORRIS PARK AVE
BRONX NY
10461-1949
US

IV. Provider business mailing address

1225 MORRIS PARK AVENUE
BRONX NY
10461
US

V. Phone/Fax

Practice location:
  • Phone: 718-430-8500
  • Fax:
Mailing address:
  • Phone: 716-323-0031
  • Fax: 716-323-0292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number323795
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: