Healthcare Provider Details

I. General information

NPI: 1659204337
Provider Name (Legal Business Name): ASTRUDE LEGER SEVERE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

44 COURT ST STE 1217
BROOKLYN NY
11201-4410
US

IV. Provider business mailing address

1112 REMSEN AVE APT 2F
BROOKLYN NY
11236-3465
US

V. Phone/Fax

Practice location:
  • Phone: 347-479-1868
  • Fax:
Mailing address:
  • Phone: 917-702-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: