Healthcare Provider Details

I. General information

NPI: 1124649629
Provider Name (Legal Business Name): TULIO BRASILEIRO SILVA PACHECO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 STATION PLZ N STE 300
MINEOLA NY
11501-3893
US

IV. Provider business mailing address

1501 PROSPECT AVE
EAST MEADOW NY
11554-4836
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-8707
  • Fax:
Mailing address:
  • Phone: 917-244-4662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number336982
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: