Healthcare Provider Details

I. General information

NPI: 1376748558
Provider Name (Legal Business Name): PHEDRE PHARA PAULEMON MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PHARA PAULEMON RN, NP

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 LINDEN BLVD
BROOKLYN NY
11203-2709
US

IV. Provider business mailing address

2525 NOSTRAND AVE APT 2C
BROOKLYN NY
11210-4715
US

V. Phone/Fax

Practice location:
  • Phone: 917-907-0797
  • Fax: 718-540-8678
Mailing address:
  • Phone: 954-867-6982
  • Fax: 917-933-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12.0095564
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2598428
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343011
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number343011
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: