Healthcare Provider Details

I. General information

NPI: 1376431239
Provider Name (Legal Business Name): RENATA CALASANS PORTUGAL DE OLIVEIRA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE
BRONX NY
10457-2545
US

IV. Provider business mailing address

4422 3RD AVE
BRONX NY
10457-2545
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-9000
  • Fax:
Mailing address:
  • Phone: 718-960-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF05250561
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: