Healthcare Provider Details

I. General information

NPI: 1285587428
Provider Name (Legal Business Name): TESHONNE POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 8TH AVE
NEW YORK NY
10018-1618
US

IV. Provider business mailing address

620 8TH AVE
NEW YORK NY
10018-1618
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 646-941-7645
  • Fax: 929-596-7897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number003250
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: