Healthcare Provider Details

I. General information

NPI: 1376406140
Provider Name (Legal Business Name): CARL YOURI TELEUS PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 BEDFORD AVE
BROOKLYN NY
11226-5403
US

IV. Provider business mailing address

215 W 95TH ST APT 7G
NEW YORK NY
10025-6354
US

V. Phone/Fax

Practice location:
  • Phone: 844-400-1975
  • Fax:
Mailing address:
  • Phone: 786-425-7633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407716
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: