Healthcare Provider Details

I. General information

NPI: 1518891555
Provider Name (Legal Business Name): REDIET TADESSE AMARE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY BROOKLYN
NEW YORK CITY NY
11206
US

IV. Provider business mailing address

ST. JOSEPH CHURCH, NIFAS SILK LAFTO
ADDIS ABABA ADDIS ABABA
01000
ET

V. Phone/Fax

Practice location:
  • Phone: 718-963-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: