Healthcare Provider Details

I. General information

NPI: 1043232143
Provider Name (Legal Business Name): GRACE FAMILY MEDICAL PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 E 96TH ST 2ND FL
BROOKLYN NY
11236-3903
US

IV. Provider business mailing address

1222 E 96TH ST 2ND FLOOR
BROOKLYN NY
11236-3903
US

V. Phone/Fax

Practice location:
  • Phone: 718-257-3355
  • Fax: 718-257-4562
Mailing address:
  • Phone: 718-257-3355
  • Fax: 718-257-4562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number149698
License Number StateNY

VIII. Authorized Official

Name: DR. BERNADETTE LIZINA SHERIDAN
Title or Position: MD
Credential: MD
Phone: 718-257-3355