Healthcare Provider Details

I. General information

NPI: 1356195382
Provider Name (Legal Business Name): RENA SHEMA FLETCHER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 BAINBRIDGE AVE FL 7
BRONX NY
10467-2404
US

IV. Provider business mailing address

241 WESTSIDE AVE
HAVERSTRAW NY
10927-1214
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-2626
  • Fax: 718-652-1833
Mailing address:
  • Phone: 585-270-9384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF353671-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: