Healthcare Provider Details

I. General information

NPI: 1386570919
Provider Name (Legal Business Name): FOOT BLISS WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 FLATBUSH AVE
BROOKLYN NY
11226-3102
US

IV. Provider business mailing address

820 FLATBUSH AVE
BROOKLYN NY
11226-3102
US

V. Phone/Fax

Practice location:
  • Phone: 718-772-9099
  • Fax:
Mailing address:
  • Phone: 718-772-9099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY MAY NICHOLAS
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 718-772-9099