Healthcare Provider Details

I. General information

NPI: 1528987385
Provider Name (Legal Business Name): TELESA DAMRAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7119 80TH ST STE 8213
GLENDALE NY
11385-7733
US

IV. Provider business mailing address

342 EUCLID AVE
BROOKLYN NY
11208-2724
US

V. Phone/Fax

Practice location:
  • Phone: 833-288-4762
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: