Healthcare Provider Details

I. General information

NPI: 1851256580
Provider Name (Legal Business Name): MS. PTALISHA RUTH PERICLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WASHINGTON ST APT 6E
HEMPSTEAD NY
11550-3131
US

IV. Provider business mailing address

150 WASHINGTON ST APT 6E
HEMPSTEAD NY
11550-3131
US

V. Phone/Fax

Practice location:
  • Phone: 646-796-1857
  • Fax:
Mailing address:
  • Phone: 646-796-1857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number355491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: