Healthcare Provider Details

I. General information

NPI: 1710536594
Provider Name (Legal Business Name): STEPHANIE OWUSU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 WILSON AVE
BROOKLYN NY
11237-8019
US

IV. Provider business mailing address

238 WILSON AVE
BROOKLYN NY
11237-8019
US

V. Phone/Fax

Practice location:
  • Phone: 347-586-9757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number707649
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403089
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: