Healthcare Provider Details

I. General information

NPI: 1285500900
Provider Name (Legal Business Name): KATERINA SAFONOVA NP ADULT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BRIGHAM ST FL 2
BROOKLYN NY
11235-1003
US

IV. Provider business mailing address

2401 BRIGHAM ST FL 2
BROOKLYN NY
11235-1003
US

V. Phone/Fax

Practice location:
  • Phone: 917-538-8914
  • Fax:
Mailing address:
  • Phone: 917-538-8914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATERINA SAFONOVA
Title or Position: OWNER
Credential: NP, PMHNP
Phone: 917-538-8914