Healthcare Provider Details

I. General information

NPI: 1164969226
Provider Name (Legal Business Name): JOANN PAOLETTI PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 FASHION AVE FL 17
NEW YORK NY
10018-7595
US

IV. Provider business mailing address

77 CHICAGO AVE
STATEN ISLAND NY
10305-3757
US

V. Phone/Fax

Practice location:
  • Phone: 917-408-1668
  • Fax:
Mailing address:
  • Phone: 718-442-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number413173-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402621
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: