Healthcare Provider Details

I. General information

NPI: 1861488959
Provider Name (Legal Business Name): NANCY TALAVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE # NS52
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

135 EASTERN PKWY APT 10L
BROOKLYN NY
11238-6071
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-2003
  • Fax:
Mailing address:
  • Phone: 718-312-2241
  • Fax: 347-402-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number186602
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: