Healthcare Provider Details

I. General information

NPI: 1154947307
Provider Name (Legal Business Name): DESIREE JANELL DARRISAW CHNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 FORT WASHINGTON AVE
NEW YORK NY
10032-3729
US

IV. Provider business mailing address

680 TINTON AVE APT 7B
BRONX NY
10455-2217
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-3408
  • Fax: 212-305-4085
Mailing address:
  • Phone: 917-969-0114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number320095
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number320095
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: