Healthcare Provider Details

I. General information

NPI: 1194477976
Provider Name (Legal Business Name): MICHELLE EDTHA ROSE-DOWDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2022
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1822
US

IV. Provider business mailing address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1822
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-5000
  • Fax:
Mailing address:
  • Phone: 718-604-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number348568-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number348568
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: