Healthcare Provider Details

I. General information

NPI: 1114635760
Provider Name (Legal Business Name): BRANNY FAUSTO TAVAREZ MELENDEZ FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 02/28/2026
Certification Date: 02/28/2026
Deactivation Date: 02/18/2026
Reactivation Date: 02/23/2026

III. Provider practice location address

3709 FLATLANDS AVE
BROOKLYN NY
11234-3507
US

IV. Provider business mailing address

102 WOODLAND AVE
NEW ROCHELLE NY
10805-2027
US

V. Phone/Fax

Practice location:
  • Phone: 717-444-7766
  • Fax: 718-285-3631
Mailing address:
  • Phone: 646-698-1876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF358918
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: